Dissertations / Theses on the topic 'Sida acuta'

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A família Geminiviridae é composta por vírus com genoma de DNA circular de fita simples, encapsidado por uma única proteína estrutural em partículas icosaédricas geminadas. A família é dividida em sete gêneros com base no tipo de inseto vetor, gama de hospedeiros, organização genômica e relacionamento filogenético. Os vírus pertencentes ao gênero Begomovirus possuem um ou dois componentes genômicos e são transmitidos pela mosca-branca Bemisia tabaci a plantas dicotiledôneas. Os begomovírus infectam naturalmente diversas espécies de plantas não-cultivadas, como Sida spp. e Macroptilium spp. Estes hospedeiros não-cultivados podem abrigar populações virais com uma maior diversidade genética. Entretanto, algumas populações virais parecem estar confinadas em determinadas espécies de plantas não-cultivadas. Com base na observação de plantas não-cultivadas emergindo no campo com sintomas de infecção por begomovírus, aparentemente na ausência do inseto vetor, e em relatos recentes de transmissão de begomovírus via semente em batata-doce, feijoeiro e tomateiro, este estudo teve como objetivo analisar a presença de begomovírus em sementes de Sida acuta e Sida rhombifolia, bem como a transmissão desses vírus via semente. Um total de 39 plantas dessas duas espécies, apresentando sintomas típicos da infecção por begomovírus, foram coletadas em Viçosa, MG, em dezembro de 2013, e transferidas para casa-de-vegetação. A infecção viral foi confirmada em 38 plantas por meio de extração de DNA total de tecido foliar seguido de amplificação por círculo rolante (rolling-circle amplification, RCA). Os produtos da amplificação foram clonados e sequenciados, confirmando-se a infecção pelo Sida yellow mosaic virus (SiYMV) nas plantas de S. rhombifolia e pelo Sida yellow leaf curl virus (SiYLCV) nas plantas de S. acuta. Aproximadamente 320 mil sementes foram coletadas das 38 plantas infectadas. As sementes foram tratadas superficialmente com hipoclorito de sódio ou com ácido sulfúrico e foram maceradas em grupos de 20, 30 ou 200 sementes. O DNA total extraído de aproximadamente 80 mil sementes foi utilizado para detecção viral via RCA, com resultados negativos. DNA total foi extraído também de flores inteiras e de tecidos florais (sépalas, pétalas, estames, estiletes e ovários) das plantas infectadas, e utilizado para detecção viral com resultados positivos em todos os casos. Sementes proveniente das plantas infectadas foram tratadas com ácido sulfúrico, germinadas e 269 plântulas provenientes dessas sementes foram avaliadas para a presença dos vírus via RCA e PCR, com resultados negativos. Em conjunto, os resultados indicam que o SiYMV e o SiYLCV são capazes de infectar os tecidos florais de Sida rhombifolia e de Sida acuta, respectivamente, entretanto não são transmitidos pelas sementes desses hospedeiros.
The family Geminiviridae is comprised of viruses with a circular, single-stranded DNA genome encapsidated by a single structural protein in geminate, icosahedral particles. The family is divided into seven genera base on the type of insect vector, host range, genomic organization and phylogeny. Viruses classified in the genus Begomovirus have one or two genomic components and are transmitted in nature by the whitefly Bemisia tabaci to dicot plants. Begomoviruses naturally infect several non-cultivated hosts, such as Sida spp. and Macroptilium spp. These non-cultivated hosts may harbor viral populations with a high degree of genetic diversity. Nevertheless, some viral populations seem to be confined to certain species of non- cultivated plants. Based on the observation of non-cultivated plants newly emerged in the field already showing symtpoms of begomovirus infection, apparently in the absence of the insect vector, and on recent reports of seed transmission of begomoviruses in sweet potato, bean and tomato, the objective of this study was to analyze the presence of begomoviruses in seeds of Sida acuta and Sida rhombifolia, as well as the transmission of these viruses by seed. A total of 39 plants of these two species, displaying typical symptoms of infection by begomoviruses, were collected in Viçosa, MG, on December 2013, and transferred to a greenhouse. Viral infection was confirmed in 38 of these plants by total DNA extraction followed by rolling- circle amplification (RCA) of complete viral genomes. Amplification products were cloned and sequenced, confirming infection of S. rhombifolia by Sida yellow mosaic virus (SiYMV) and of S. acuta by Sida yellow leaf curl virus (SiYLCV). Approximately 320,000 seeds were collected from the 38 infected plants. The seeds were surface-sterilized with sodium hypochloride or sulphuric acid, and were ground in groups of 20, 30 or 200 seeds. Total DNA extracted from approximately 80,000 seeds was used for viral detection by RCA, with negative results. Total DNA was also extracted from whole flowers and from flower tissues (sepals, petals, stamens, styles and ovaries) from infected plants and used for viral detection, with positive results in all cases. Seeds from infected plants were treated with sulphuric acid, germinated and 269 plantlets from these seeds were evaluated for the presence of virus by RCA and PCR, with negative results. Together, these results indicate that SiYMV and SiYLCV are capable of infecting the flower tissues of Sida rhombifolia and Sida acuta, respectively, however they are not transmitted by seeds in these hosts.

Cimetidine is a histamine H2-receptor antagonist that is among the most widely prescribed drugs in the world. In addition to its inhibitory action on gastric acid secretion, a possible role in kidney tubulointerstitial disease has been suggested. Isolated reports have also suggested an association between cimetidine administration and acute interstitial nephritis. The present study examined the effect of cimetidine on renal function in the rat. The nine rats used in this study had normal renal function and urinalyses before treatment with cimetidine. The cimetidine treated rats then developed a clinical picture of weakness, hematuria, proteinuria, casturia, oliguria, and increases in serum blood urea nitrogen and creatinine.Following the 6 weeks treatment period, all rats were sacrificed and their kidneys prepared for microscopic study. Histologically, the patchy, intense tubulointerstitial infiltration of lymphocytes, plasma cells, and other cells observed in the cortex of the rat kidneys is quite similar to findings described in human cases of drug-induce hypersensitivity tubulointerstitial disease. In addition, other pathologic conditions which can cause tubulointerstitial disease were adequately ruled out. Specifically, bacterial pyelonephritis was excluded as a result of the consistently sterile urine test. In conclusion, the author feels that the clinical, aboratory, and histologic findings in this study strongly suggests an association between of tubulointerstitial disease and the use of cimetidine.
Department of Physiology and Health Science

Schizophrenia is a debilitating psychiatric condition affecting almost one percent of the US population. Typical antipsychotics (e.g., haloperidol) have been in use for several decades and are generally very effective in treating the emotional and cognitive effects of schizophrenia, but are used as the last line of treatment due to their severe extrapyramidal motor side effects under chronic exposure. The present study was conducted to investigate the role of sex in determining the oromotor side effects of typical antipsychotics via measuring different behavioral dimensions of male and female Sprague-Dawley rats licking sucrose after haloperidol treatment. The results showed a stronger sensitivity in female rats than male rats within total licking responses and inter-lick intervals. The present results suggest closer attention needs to be paid to the role that sexual hormones play in the motor slowing and behavior-reducing effects of antipsychotics.

SAMMANFATTNING  Syfte Syftet med denna studie var att undersöka anledningen till att vissa familjer väljer att söka akutsjukvård till sina barn istället för att vända sig till andra vårdinstanser.  Metod En enkät utformades för studien. Enkäten delades ut till familjer som sökte för icke akuta åkommor på en barnakutmottagning i Uppsala län. Studien pågick under en tolvdagarsperiod och avslutades när 80 familjer besvarat enkäten. Frågorna bearbetades med hjälp av beskrivande statistik samt chi2-test.  Resultat Den huvudsakliga anledningen till att man valde att söka på barnakutmottagningen var att man telefonledes blivit hänvisad av annan vårdinstans (73,8%). Av de familjer som varit i kontakt med annan vårdinstans hade 70% hänvisats via sjukvårdsrådgivningen/1177.De vanligaste åkommorna som det söktes för var andningsbesvär, luftvägsinfektioner och bukbesvär. Någon skillnad i sökmönster beroende på demografiska faktorer kunde inte urskiljas.  Slutsats Studien visade att anledningen till att familjer sökte akutsjukvård för icke akuta åkommor i mycket stor grad berodde på att man hänvisats till barnakutmottagningen av annan vårdinstans. Det är således inte familjernas intention att söka akut i första hand utan systemets utformning som styr familjerna till barnakutmottagningen.
ABSTRACT  Aim The aim was to evaluate why families visited the pediatric emergency department with non-acute conditions instead of seeking other healthcare providers.  Method A questionnaire was constructed and distributed to families that visited a pediatric emergency department in Uppsala county. The study was terminated after twelve days. 80 families were included. The results were evaluated with descriptive statistics as well as Chi2-test.  Results The most common reason (73,8%) for visiting the pediatric emergency department was that the families had been instructed by phone to do so by another health care provider. Of the families that had been referred by another health care provider 70% had been referred by the ”Sjukvårdsrådgiving/1177”. The most common reasons for the visit were troubles with breathing, upper air way infection and abdominal problems. There were no discernable differences in the visiting patterns due to demographic differences.  Conclusion The study shows that the reason that families visited the pediatric emergency department for for non-acute conditions to a large degree was that they had been recommended to do so by another health care provider. It is thus not the families own intention to primarily visit the pediatric emergency department but the health care system channels them there.

Abstract Acute pancreatitis is a common disease, Finland being among the countries with the highest incidence. The majority of patients have a mild, self-limiting disease. However, 20% of these patients develop severe necrotizing pancreatitis with a mortality rate of 7 to 25%. The mechanisms for developing the severe disease are not known, it is not possible to accurately forecast the severity of the disease and there is no curative treatment yet. This study was aimed at analyzing the early phase of acute experimental porcine oedematous and necrotizing pancreatitis. In Study I, the pancreatic microcirculatory changes were measured and the expression of tight junction proteins (claudins-2, -3, -4, -5 and -7) and the rate of apoptosis in the pancreas were all measured. In Study II, bacterial translocation to the blood in the portal vein blood or to the mesenteric lymph nodes was analyzed and the intestinal expression of tight junction proteins (claudins-2, -3, -4, -5 and -7) and the intestinal apoptosis/ proliferation rates were measured. The basic histology of the jejunum and colon were analyzed. Study III analyzed which cytokines are released from the pancreas to the portal venous blood. In Study IV, the ultrastructure of the epithelium of the jejunum and colon was analyzed and the expression of adherens junction proteins, E-cadherin and β-catenin, were measured from both jejunum and colon. The first study (I) showed that membranous immunoreactivity of claudin-2 in acinar cells appeared in the pancreas during acute oedematous and necrotizing pancreatitis. The expressions of claudins -3, - 4, - 5 and 7 were unaffected. The second study (II) showed that bacterial translocation from the gut was not present at the beginning of acute porcine pancreatitis. The expressions of claudins-2 and -5 do not become altered; however, there might be some decrease in claudin-3 expression in the colon and decrease in the expression of claudins-4 and -7 in the jejunum in necrotizing pancreatitis. Performing the laparotomy itself caused increased apoptosis in the colon and the jejunum. In the third study (III), the initial inflammatory process was diverse in oedematous and necrotizing pancreatitis. Increased monocyte count in combination with elevated PDGF and IL-6 are characteristic of necrotizing pancreatitis in our model. The fourth study (IV) indicated that necrotizing pancreatitis caused damage to the epithelial and endothelial cells of the colon in the early stages of the disease. The expression of E-cadherin immunoreactivity showed a decreasing trend in the colon in both oedematous and necrotizing pancreatitis. The results of this study suggest that claudin-2 increases in acinar cells during acute porcine pancreatitis. Bacterial translocation is not present during the early phase of acute porcine pancreatitis. Increased monocyte count and elevated PDGF and IL-6 are characteristic of early phase necrotizing porcine pancreatitis and necrotizing porcine pancreatitis causes damage to the epithelial and endothelial cells of the colon
Tiivistelmä Akuutti haimatulehdus on yleinen sairaus, jonka ilmaantuvuus Suomessa on verrattain suuri. Suurimmalla osalla potilaista tauti on lievä ja itsestään paraneva. Kuitenkin 20 %:lle potilaista kehittyy vaikea haimatulehdus, johon liittyy 7–25 %:n kuolleisuus. On epäselvää, miksi toisinaan kehittyy vaikea tautimuoto. Taudin vaikeusastetta ei voida etukäteen tarkasti ennustaa, eikä tautiin ole parantavaa hoitoa. Väitöskirjatyön tarkoituksena oli tutkia lievän ja vaikean haimatulehduksen varhaisvaihetta kokeellisessa sikamallissa. Työssä I mitattiin haiman mikroverenkierron muutoksia, tutkittiin tiivisliitosproteiinien klaudiini-2:n, -3:n, -4:n, -5:n ja -7:n ilmenemistä sekä apoptoosin määrää haimassa. Toisessa työssä tutkittiin mahdollista bakteeritranslokaatiota porttilaskimovereen ja vatsaontelon imusolmukkeisiin, mitattiin suoliston tiivis liitos-proteiinien klaudiinien-2, -3, -4, -5 ja -7 ilmenemistä ja suoliston apoptoosin ja soluproliferaation määrää. Mahdollisia muutoksia ohut- ja paksusuolen perushistologiassa analysoitiin. Kolmannessa työssä mitattiin sytokiinipitoisuuksia porttilaskimoverestä. Neljännessä työssä analysoitiin ohut- ja paksusuolen mikrorakennetta elektronimikroskopian avulla ja mitattiin vyöliitosproteiinien E-cadherin ja β-catenin määrää. I työssä todettiin klaudiini-2:n ilmaantuvan haiman asinaarisolujen solukalvoille lievässä ja vaikeassa kokeellisessa haimatulehduksessa. Klaudiinien 3,- 4,- 5 ja 7 esiintyminen haimassa ei muuttunut. II työssä todettiin, että bakteeritranslokaatiota ei tapahtunut seuranta-aikana. Suolistossa klaudiinien-2 ja -5 ilmenemisessä ei tapahtunut muutoksia. Klaudiini-3:n ilmenemisessä paksusuolessa ja klaudiinien -4 ja -7 ilmenemisessä ohutsuolessa saattaa tapahtua vähenemistä vaikeassa haimatulehduksessa. Tutkimustoimenpide itsessään aiheutti ohut- ja paksusuolen apoptoosin lisääntymistä. III työn mukaan tulehdusvaste oli erilainen akuutissa lievässä ja vaikeassa kokeellisessa haimatulehduksessa. Monosyyttimäärän sekä PDGF:n ja IL-6:n pitoisuuksien lisääntyminen, olivat tyypillisiä vaikealle haimatulehdukselle tässä mallissa. IV työssä todettiin, että vaikea haimatulehdus vaurioittaa paksusuolen epiteeli- ja endoteelisoluja. E-cadherin: n määrässä todettiin jonkin verran vähentymistä sekä lievässä että vaikeassa haimatulehduksessa. Näiden tulosten mukaan klaudiini-2 lisääntyy sian haiman asinaarisoluissa akuutissa haimatulehduksessa. Sialla ei tapahdu bakteerien translokaatiota haimatulehduksen varhaisvaiheessa. Sian vaikeaan haimatulehdukseen liittyy monosyyttien, PDGF:n ja IL-6:n lisääntyminen. Kokeellisessa vaikeassa haimatulehduksessa paksusuolen epiteeli- ja endoteelisolut vaurioituvat jo varhaisvaiheessa

Recently there has been an increase in awareness of the role of drugs other than alcohol in the causation of road accidents and deaths, with the most recent report indicating that 33% of all Victorian (Australia) road fatalities are drug (other than alcohol) related (TAC, 2006). Currently in Victoria, one of the classes of drugs reported to be of most concern is the amphetamines. The epidemiological driving literature highlights a possible association between amphetamine use and road crashes. However, since the cognitive research generally indicates cognitive enhancing properties following amphetamine consumption, it remains unclear how amphetamines may be related to adverse driving. The present thesis was designed to explore this issue. In response to the increasing number of drug-related road fatalities, the Standardised Field Sobriety Tests (SFSTs), designed and validated for the detection and assessment of impairment associated with alcohol intoxication, are currently being employed by the Victoria Police (Australia) for the identification of driving impairment associated with drugs other than alcohol. The present thesis was designed to evaluate whether the SFSTs are a sensitive measure for identifying impairment associated with a single acute therapeutic amphetamine dose. Furthermore, the accuracy of using the SFSTs to detect driving impairment associated with these amphetamine doses was also evaluated. The present thesis examined the effects of a single acute therapeutic dose of various amphetamine preparations, on simulated driving performance, driving-related cognitive processes (assessed using standard cognitive tasks and the electroencephalogram [EEG]), and performance on the SFSTs, in healthy, stimulant-using, non-fatigued adults. The present thesis consisted of five separate experiments. The first three experiments examined the effects of d-amphetamine, d,l-methamphetamine, and d-methamphetamine, on simulated driving performance, driving-related cognitive processes, and performance on the SFSTs. Experiment 4 and Experiment 5 assessed the effects of d-amphetamine and dmethamphetamine on visual and auditory cognitive processes using the EEG. These forms of amphetamines were selected as they are commonly used recreationally by young adult drivers, and occupationally by truck drivers. Experiment 1, Experiment 2, and Experiment 3 employed a repeated-measures, counterbalanced, double blind, placebo-controlled design. In each experiment, twenty different (i.e. 60 participants in total) healthy volunteers (10 males and 10 females) completed two treatment conditions i) placebo and ii) 0.42mg/kg amphetamine (~30mg). Driving performance was assessed using a driving simulator task, which consisted of four driving tasks; �freeway traffic driving� and �city traffic driving� in both day and night conditions. Cognitive performance was assessed using a range of computer and pen and paper tasks designed to assess attention, psychomotor performance, and perceptual speed. Specifically, the tasks were: the Digit Span Test; a Digit Vigilance task; a Movement Estimation Task; the Digit Symbol Substitution Test; a Tracking Task; the Trail-Making Test; and the Inspection Time task. SFSTs performance was assessed using the Horizontal Gaze Nystagmus (HGN) test, the Walk and Turn (WAT) test, and the One Leg Stand (OLS) test. Three blood and saliva samples were obtained throughout all experimental sessions (120, 170, and 240 minutes after drug administration). The results indicated that 0.42mg/kg d-amphetamine significantly impaired simulated driving performance, in recreational stimulant users, 2-3 hours post-drug administration, when mean blood amphetamine concentrations were approximately 90ng/mL. No significant driving decrements were observed following d,l-methamphetamine or dmethamphetamine, when methamphetamine blood concentrations were 90ng/mL and 70ng/mL, respectively. There were only few driving behaviours that were found to be significantly reduced with d-amphetamine, such as reductions in signalling adherence and driving too fast for the traffic conditions. However, during all three amphetamine conditions, drivers travelled at a slower speed on the freeway at the time that an emergency situation occurred, relative to the placebo condition. It was argued that either this may result from more cautious driving, or that the reduction in speed acted as a compensatory mechanism to permit drivers to attend to other aspects of driving. Overall, the present results indicate that a therapeutic dose of amphetamine does not produce considerable impairment to driving, as only minimal amphetamine effects were observed on driving performance. In terms of cognitive performance, the results indicated that a therapeutic dose of various amphetamines has minimal effect on driving-related cognitive functioning, with some significant improvements noted in aspects of attention, psychomotor functioning and perceptual speed. This is consistent with the failure to identify significant driving impairments, described above, following a similar dose. However, the ability to perceive and predict motion and estimate �time to contact�, assessed using a movement estimation task, was affected following d-amphetamine and d-methamphetamine consumption. In terms of performance on the SFSTs, the present thesis demonstrated that following the administration of low-level d-amphetamine, d,l-methamphetamine, and dmethamphetamine, performance on the SFSTs was not impaired. Using the SFSTs, impairment associated with low dose d-amphetamine was identified in only 5% of cases, dmethamphetamine in 5% of cases, and d,l-methamphetamine in 0% of cases. These findings indicate that the degree of impairment produced with the low amphetamine dosing conditions was below the threshold of sensitivity of the SFSTs. However, as significant impairments in driving were not observed with amphetamines, the present SFSTs findings highlight that these tests are unlikely to produce false positive results during police drug evaluation procedures for amphetamine-related impairments. Experiment 4 and Experiment 5 similarly employed a repeated-measures, counterbalanced, double blind, placebo-controlled design. In each experiment, twenty healthy volunteers (10 males and 10 females) completed two treatment conditions i) placebo and ii) 0.42mg/kg amphetamine (~30mg). Tasks designed to assess visual and auditory cognitive functions relevant to driving were administered. Specifically, these processes were: divergent visual system pathways (magnocellular and parvocellular pathways); aspects of visual field processing (central and peripheral visual fields); mismatch negativity (MMN); prepulse inhibition (PPI); selective attention; resource allocation; and speed of processing. Two blood and saliva samples were obtained throughout all experimental session (120 and 200 minutes after drug administration). d-amphetamine and d-methamphetamine generally improved cognitive functioning, as assessed with visual and auditory ERP indices. Specifically, the results demonstrated that a low-level acute dose of d-amphetamine and d-methamphetamine improved early processing of visual information (indexed by improvements to the P100 component for the magnocellular and parvocellular visual pathways). In addition, d-methamphetamine improved the speed at which visual information was evaluated and processed (indexed by decreases in P300 latency), which was consistent with d-methamphetamine-related improvements in reaction time. There was a trend for d-amphetamine to improve the speed that changes in auditory stimulation were automatically detected (indexed by decreases in MMN latency). In addition, d-methamphetamine improved the ability to automatically �screen out� irrelevant and intrusive auditory information (indexed by increases in PPI of the startle response). d-amphetamine was found to improve the speed at which auditory information was evaluated and processed (indexed by decreases in P300 latency), which was substantiated with corresponding improvements in reaction time and accuracy. Although amphetamines were generally shown to enhance ERP indices, a trend was found for d-amphetamine to differentially affect different regions of the visual field, in terms of selective attention. Specifically, there was a trend-level indication that d-amphetamine improved indices of selective attention (denoted by increases in N200 amplitude) for information presented centrally, but impaired indices of selective attention (denoted by decreases in N200 amplitude) for information presented in the periphery. Although impairments to the peripheral visual field were not similarly observed with dmethamphetamine, decrements to indices of selective attention (denoted by decreases in N200 amplitude) were also found with d-methamphetamine during the auditory oddball task. In terms of driving, these results suggest that drivers dosed with low-level amphetamine may not selectively attend to and discriminate changes within the traffic environment, although further research is required to confirm this. In conclusion, the present thesis has demonstrated that a single acute therapeutic dose of amphetamine produces minimal and inconsistent effects to driving. However, some (inconsistent) evidence was found that suggests that there may be mild impairments such as decreased ability to perceive and predict motion, tunnel vision effects, and decrements to selective attention. In addition, the present thesis highlights that at therapeutic doses, amphetamines do not impair SFSTs performance, which is in accordance with the failure to identify substantive amphetamine-related decrements to driving and cognitive functioning observed in the present thesis.

Thesis (PhD) - Swinburne University of Technology, 2006.
Typescript. [Submitted for the degree of] Doctor of Philosophy, Swinburne University of Technology - 2006. Includes bibliographical references (p. 253-290).

Introdução: Vancomicina, considerada o antibiótico de primeira escolha para o tratamento de infecções estafilocócicas, é eliminada por filtração glomerular, e a sua administração deve ser individualizada de acordo com a função renal. As diretrizes atuais recomendam doses e níveis séricos maiores, para aumentar as chances de bons resultados clínicos. Questiona-se se esta estratégia causaria maior nefrotoxicidade. Objetivos: Comparar a frequência de injúria renal aguda (IRA) em pacientes com suspeita de infecção estafilocócica tratados com vancomicina ou com outros antimicrobianos com o mesmo perfil terapêutico em um hospital terciário. Analisar a associação do uso de vancomicina com o desenvolvimento de IRA nestes pacientes. Avaliar os fatores de risco associados ao desenvolvimento de IRA nos pacientes tratados com vancomicina. Identificar os fatores de risco associados à letalidade precoce e tardia nos pacientes com suspeita de infecção estafilocócica tratados com vancomicina ou outros antimicrobianos com o mesmo perfil terapêutico. Métodos: Foram analisados os prontuários dos pacientes com suspeita de infecção estafilocócica que receberam os antimicrobianos vancomicina, teicoplanina, oxacilina, daptomicina ou linezolida por pelo menos três dias nos anos de 2010 e 2011 em um hospital terciário. Analisou-se a frequência de IRA associada ao uso de vancomicina (critério KDIGO) e. por regressão logística, se o uso de vancomicina foi associado ao desenvolvimento de IRA. Avaliou-se por regressão logística os fatores de risco associados ao desenvolvimento de IRA no grupo de pacientes tratados com vancomicina. Analisou-se por regressão de Cox os fatores de risco para letalidades intra-hospitalar, seis meses e até um ano após a internação. Resultados: Foram incluídos 591 pacientes, dos quais 508 foram expostos à vancomicina e 83 foram expostos a teicoplanina, oxacilina, linezolida, ou daptomicina. IRA ocorreu em 28,5% dos pacientes que utilizaram vancomicina e em 14,5% dos que utilizaram outros antimicrobianos (p < 0,001). O grupo de pacientes tratados com vancomicina apresentou parâmetros sugestivos de maior gravidade, como maior frequência de culturas positivas para estafilococos, hipotensão grave, contagem de leucócitos em sangue periférico mais elevada e níveis séricos maiores de lactato, procalcitonina e PCR. Quando pacientes que desenvolveram IRA foram comparados com pacientes que mantiveram a função renal estável, observou-se que o uso de vancomicina, a duração do tratamento e nível sérico de vancomicina foram significativamente maiores entre os primeiros. Vancomicina foi identificada como fator independente para o desenvolvimento de IRA na regressão logística. Os fatores de riscos independentes para o desenvolvimento de IRA no grupo exposto à vancomicina foram uso de medicamentos nefrotóxicos ou que alteram a função renal, uso de medicamento vasopressor e concentração sérica de vancomicina >= 20 mg/L. Vancomicina não se associou a letalidade em nenhum dos períodos estudados, enquanto IRA se associou de forma independente à letalidade precoce e tardia. Conclusões: Estes resultados indicam que a vancomicina apresenta nefrotoxicidade significativa e que os seus níveis séricos devem ser obrigatoriamente avaliados. O uso de medicamentos nefrotóxicos ou que alteram a função renal deve ser, quando possível, evitado ou suspenso em pacientes tratados com vancomicina. O desenvolvimento de IRA, mas não o uso de vancomicina, foi fator independente para letalidade, reforçando que este antimicrobiano pode ser utilizado quando indicado, desde que se previna o desenvolvimento de IRA
Introduction: Vancomycin is considered the first choice antibiotic for treatment of staphylococcus infection. Vancomycin is eliminated through glomerular filtration, and so it is administration must be individualized according the renal function. Current treatment guidelines recommend higher doses and blood levels in order to increase the odds for an adequate clinical outcome. On the other hand, this strategy might cause higher vancomycin-associated nephrotoxicity. Objectives: To analyze the frequency of acute kidney injury (AKI) development in patients with suspicion of staphylococcus infection treated with vancomycin, or other antibiotics with the same therapeutic profile in a tertiary hospital. To analyze the association of vancomycin with AKI development in those patients. To analyze the risk factors for AKI development in vancomycin-treated patients. To identify the risk factors associated to early and late mortality in patients with suspicion of staphylococcus infection treated with vancomycin, or other antibiotics with the same therapeutic profile in a tertiary hospital.Methodology:We analyzed the files of all the patients with suspicion of staphylococcus infection treated with vancomycin, teicoplanin, oxacillin, daptomycin, or linezolid antibiotics for at least three days during the years of 2010 and 2011 in a tertiary hospital.The frequency of AKI development (KDIGO criteria) was assessed. Using logistic regression we assessed if vancomycin use was an independent risk factor for AKI development and the risk factors for AKI development in the group of patients treated with vancomycin. We assessed, using Cox regression, the risk factors for in-hospital, six months and one year after hospitalization mortality. Results: We included 591 patients in the final analysis, 508 using vancomycin and 83 using other antibiotics (teicoplanin, oxacillin, daptomycin, or linezolid). AKI developed in 28.5% of the vancomycin group compared with 14.5% in the other antibiotics group (p < 0.001). Patients treated with vancomycin showed parameters suggesting higher clinical severity, such as higher percent of staphylococcus positive cultures, severe hypotension, higher leukocytes blood count, higher serum levels of lactate, procalcitonin and CRP. When patients developing AKI were compared with patients maintaining preserved renal function, the first group showed a statistically significant higher frequency of vancomycin use, longer vancomycin treatment and higher vancomycin through levels. Using logistic regression vancomycin was identified as an independent risk factor for AKI development. The independent risk factors for AKI development in the vancomycin group were simultaneous use of vancomycin and other nephrotoxic drugs or drugs that influence renal function, vasopressor drugs use and blood levels of vancomycin >= 20 mg/L. Vancomycin was not associated with mortality in any studied time, whereas AKI was an independent risk factor for early and late mortality. Conclusions: These results indicate that vancomycin is associated with significative nephrotoxicity and that its blood levels must be mandatorily assessed. The use of drugs that are nephrotoxic or influence renal function must be, when feasible, avoided or halted in vancomycin-treated patients. AKI development, but not vancomycin use, was an independent risk factor for mortality, reinforcing the perception that vancomycin can be used when necessary, since AKI development is prevented

The purposes of this study are: a) to understand the treatments compliance behavior of the patient with chronic disease at the behavioral level, particularly, the relationship between treatments compliance behavior and normative beliefs; b) develop a behavioral model of patient's treatments compliance behavior that could be used for predicting, combating, treating, tracking and controlling the treatments compliance behavior of the patients with chronic disease. Seventy-two patients from senior daycare centers in the Dallas area, who suffer or had suffered from at least, one chronic disease, participated in the study. Data gathering was conducted using paper-based questionnaire. The most significant finding of this study is the relationship between normative beliefs and the treatments compliance behavior of the patient with chronic disease. Normative beliefs were found to have significant impact on the treatments compliance intent and behavior of the patients with chronic disease. Another important finding showed that side-effects of prescribed treatments have little or no influence on the treatments compliance behavior of the patient with chronic disease. A relationship between the effectiveness of medicine, particularly, predictive medicine, and treatments compliance behavior was established. The design of the study was intended to provide coverages for a set of constructs that may be the interacting units in the environment of any chronic disease treatments decision. It depicts relational, information communications links between the constructs. The Imhonde model of treatments compliance behavior was designed to include cultural norms and other beliefs that are significant for real-time human ailments decisions behaviors. It is recommended that further studies may include the use of a larger population of participants from diverse cultures and localities in multiple states and countries, with the object of finding the differences that culture and local environments may have on the normative leaning for treatments compliance behavioral decisions in chronic disease cases.

Postoperative pain is of serious concern to patients and anesthesia providers alike. Management of a patients’ pain is a central component of anesthesia care. Ketamine as an anesthetic agent has been available for 50 years. It has been utilized as a general anesthetic and selectively as an anesthetic agent for high-risk patients. Due to dysphoric side effects associated with the dosage required to render general anesthesia, anesthesia providers may be reluctant to utilize this medication to its full potential. Recently there has been a resurgence of interest in ketamine as an analgesic agent. The researcher for this project performed a thorough literature review focusing on intravenous ketamine as an adjunct to standard opioid-based analgesia for postoperative pain. Four systematic reviews published in the last 10 years support the safety and efficacy of ketamine when administered intravenously in sub-anesthetic doses. The purpose of this project was to provide evidence-based education to anesthesia providers regarding the benefits of ketamine and follow-up to evaluate for evidence of changes in practice after the educational At a large community hospital data concerning ketamine utilization by anesthesia providers as a component of multimodal analgesia was collected for a six-month period, including three months pre- and three months post-educational intervention. Despite various methods utilized to present evidence regarding the safety and efficacy of ketamine, the results of this study demonstrated no significant change in practice. Based upon the extensive published literature the evidence is compelling that the addition of a sub-anesthetic (0.5 mg/kg) dose of ketamine to the surgical patient’s operative pain management plan would improve comfort and decrease opioid-related side effects with minimal negative impact.

碩士
國立屏東科技大學
生物科技研究所
93
Cajanus cajan (L.) Millsp. is a small shrub that belong to Fabaceae family; Sida acuta Burm f. is an erect shrub that belong to Malvaceae family. They are widely cultivated in Taiwan and mainly used as traditional treatment for detoxification. The extract from MeOH of the seeds of C. cajan was concentrated to give a residue then suspended in H2O and partitioned sequentially using EtOAc and n-BuOH. The fractions collected were subjected to preliminary purification by silica gel, Sephadex LH-20 and Diaion HP-20 column according to their polarity. Further purification by HPLC and recrystallization to yield eighteen compounds including three tocopherols, three triterpenoids, ten steroids, one amino acid and one aromatic compound. Among those compounds, γ-tocopherol, δ-tocopherol and 5-(γ-tocopherol-5-yl)-γ-tocopherol showed significant DPPH free radical scavenging activity with IC50 values of 26.8, 35.6, 25.3 μg/ml, respectively. The extract from MeOH of the whole plant of S. acuta Burm f. was concentrated to give a residue then suspended in H2O and partitioned sequentially using CH2Cl2 and n-BuOH. The CH2Cl2 layer was purification by silica gel, HPLC and recrystallization to yield twenty-six compounds including four tocopherols, four triterpenoids, two diterpenoids, two aliphatic compounds, six steroids, four aromatics, one chlorophyll, one alkaloid, one apocartenoid and one lignin. Among those compounds, α-tocopherol, β-tocopherol, 7a-methoxy-α-tocopherol and vanillin showed significant DPPH free radical scavenging activity with IC50 value of 30.5, 28.4, 40.0, 197.0 μg/ml, respectively.

Atypical antipsychotics (AAPs) are associated with metabolic sequelae including risk of type 2 diabetes. Evidence points to a weight-gain independent and direct drug effect on glucose homeostasis. While the exact mechanisms remain elusive, the heterogeneous binding profiles of AAPs likely include receptors involved in glucose metabolism. We aimed to clarify weight-gain independent mechanisms of AAP-induced alterations in insulin secretion. Deconstruction of the receptor binding profiles of these agents was done using representative antagonists and the hyperglycemic clamp. We assessed the acute effects of several selective receptor antagonists on glucose metabolism, namely prazosin, idazoxan, MDL100907, SB242084 and WAY100635. Prazosin and MDL100907, selective α1 and 5HT2A antagonists, respectively, caused significant decreases in both insulin and C-peptide secretion. A decreased glucose infusion rate and disposition index was also found in the prazosin group. Antagonism of the α1 and 5HT2A receptors may be involved in AAP-induced glucose dysregulation, however, the responsible mechanisms remain unknown.

Neuroleptic drugs are essential in the treatment of schizophrenia and many other psychiatric disorders. These drugs do however cause a wide range of side effects which can be very distressing to patients. In particular the acute neurological side effects of parkinsonism, akathisia and dystonia, which are termed extrapyramidal syndromes, can be a limiting factor in the use of these drugs (Weiden et al 1987). Fort Napier Hospital is a large psychiatric referral hospital and the majority of patients admitted require neuroleptic drug treatment. Extrapyramidal side effects are regularly seen amongst these patients. This study was designed to discover the incidence of parkinsonism, akathisia and dystonia amongst patients treated with neuroleptic drugs and what specific factors were responsible for these side effects. Relevant literature on this topic was reviewed and comparable studies done in America, Europe and South Africa are discussed. The study sample consisted of one hundred patients who were examined regularly over a two week period for signs of parkinsonism, akathisia, or dystonia which were rated quantitatively according to specific rating scales. Patient and drug variables were then analysed to assess what factors were responsible for these side effects. The incidence of drug-induced parkinsonism was 29%, akathisia 35% and dystonia 20%. Combinations of these three syndromes were observed resulting in an overall incidence of 47%. High potency drugs such as haloperidol and trifluoperazine were responsible for a large percentage of all the side effects, while of the low potency drugs, thioridazine produced less side effects than chlorpromazine. Oral drugs combined with intramuscular depot drugs resulted in a high incidence of side effects. The phase of treatment was clinically important with dystonia occurring more often within the first three days of treatment, akathisia within ten days and parkinsonism after ten to fourteen days. Other factors that were studied included the patients age, sex and prior history of neuroleptic-induced neurological side effects. Due to the predominantly young patient population in this study, the mean age of those patients who developed parkinsonism was 26,7 years, akathisia 27,5 years and dystonia 25,8 years. These side effects were seen more commonly in males than in females. Of the 27 patients in this study who had a prior history of neurological side effects, 15 (56%) developed similar side effects following re-exposure to neuroleptic drugs. Conclusions derived from this study include the need for clinicians to select the correct type and dose of neuroleptic for individual patients in order to minimize the development of neurological side effects. Accurate, early diagnosis of side effects by regular examination of patients is necessary for effective patient management. Clinicians should be made more aware of the side effects that can develop with the use of neuroleptic drugs and the effect these side effects have on patients.
Thesis (M.Med)-University of Natal, 1993.

博士
中國醫藥大學
藥學系博士班
105
Objectives To investigate whether tamoxifen use is correlated with the risk of acute pancreatitis (AP) in breast cancer female, and whether zolpidem use is correlated with the risk of acute pyelonephritis (APN) in female patients. Methods We conducted 4 substudies using the database of the Taiwan National Health Insurance Program. In substudy 1 (case-control study), the participants comprised 612 subjects, aged ≥ 20 years with breast cancer in females, with a first bout of AP from 2000 to 2011 as cases and 6120 randomly selected age-matched subjects without AP as the controls. Tamoxifen use was defined as “current,” ”recent,” or ”past” use if the subjects who had received the last remaining one tablet for tamoxifen filled between 0–3 months, 3–6 months, or ≥ 6 months before the date of AP diagnosis, respectively. A multivariate unconditional logistic regression model was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for AP associated with the use of tamoxifen. The same model was applied in substudy 4. Both substudies 2 and 3 were cohort studies; the substudy 3 included more comorbidities than substudy 2, and the substudy 3 was employed 2 design (without PS-matching, and PS-matching designs). Their patients with new-onset breast cancer who were aged ≥20 years during 2000 to 2009 and assigned the index date as the date of cancer diagnosis. The end point was developing AP during the follow-up. Hazard ratios (HRs) and 95% CIs were assessed to determine the association between AP risk and tamoxifen use. Because the drug use varied over time, it was measured as a time-dependent covariate in the Cox proportional hazard model. In substudy 4, there were 3,151 female subjects aged 20–84 years with the first bout of APN (cases) and 6,015 controls without APN. Zolpidem use was defined as “immediate,” ”early,” or ”late,” if the last remaining one tablet for zolpidem was detected within 7 days, between 8–14 days or ≥ 15 days before the date of APN diagnosis, respectively. Results In substudy 1, the adjusted ORs of AP were 1.18 (95% CI 0.95–1.48), 1.43 (95% CI 0.87–2.35), 0.97 (95% CI 0.79–1.19) in subjects with current, recent, and past use, respectively. In substudy 2, and 3, the adjusted HRs of APN were 0.93 (95% CI 0.73–1.18), 0.94 (95% CI 0.74–1.19), and 0.95 (95% CI 0.71–1.26) in the substudy 2, substudy 3 (non-matching cohort), substudy 3 (PS-matching cohort), respectively. In substudy 4, the adjusted ORs of APN were 2.19 (95% CI, 1.69–2.83),1.44 (95% CI, 0.82–2.51),and 1.05 (95% CI, 0.93–1.18) in subjects with immediate, early, and late zolpidem use, respectively. Conclusion In substudy 1–3 we found no significant correlation between tamoxifen use and the risk of AP in females with breast cancer. In substudy 4, only female patients with immediate zolpidem use had a significantly increased relative risk of APN.

Thesis (M.A.)--Northern Kentucky University, 2008.
Made available through ProQuest. Publication number: AAT 1450592. ProQuest document ID: 1495953201. Includes bibliographical references (p. 30-32)

MUDr. Olga Matoušková - the dissertation theses The influence of individual genetic predisposition to the pharmacokinetics and pharmacodynamics of chosen opioids ABSTRACT Introduction: The aim of this thesis is to study the influence of polymorphism of CYP2D6 and MDR1 on the pharmacokinetics and pharmacodynamics of tramadol in healthy volunteers using measurement. A secondary objective is to evaluate these polymorphisms in relation to the analgesic efficacy and side effects of piritramide for acute postoperative pain. Materials and methods: In two prospective work studying the influence of genetic predisposition on the pharmacokinetic and pharmacodynamic parameters of tramadol, we included a total of 90 healthy volunteers. Clinical studies on opioid analgesia and influence of genetic predisposition to the pharmaco-therapeutic effects and side effects in patients with acute postoperative pain, we included a total of 161 patients with acute postoperative pain. Polymorphism genotyping CYP2D6 and MDR1 gene we performed PCR - RFLP analysis, to determine concentrations of tramadol and metabolite, we used gas and liquid chromatography and pharmacodynamic effects of opioids was evaluated by pupilometric measurement and visual analogue scale. Results and conclusion: Variability of the opioid effect is influenced by...

Thesis (M.A.)--Northern Kentucky University, 2008.
Made available through ProQuest. Publication number: AAT 1450372. ProQuest document ID: 1490083611. Includes bibliographical references (p. 44-46)

Thesis (M.A.)--Northern Kentucky University, 2009.
Made available through ProQuest. Publication number: AAT 1462510. ProQuest document ID: 1694712381. Includes bibliographical references (p. 27-29)

Thesis (Ph.D.)--State University of New York at Buffalo, 2007.
Title from PDF title page (viewed on July 18, 2007) Available through UMI ProQuest Digital Dissertations. Thesis adviser: Moysich, Kirsten B. Includes bibliographical references.

Thesis (M.A.)--Northern Kentucky University, 2009.
Made available through ProQuest. Publication number: AAT 1462563. ProQuest document ID: 1694178021. Includes bibliographical references (p. 67-69)