INTRODUÇÃO As taxas de sobrevida do enxerto em transplante renal de doador falecido são menores que aquelas de doadores vivos. Acredita-se que metabólitos de estresse oxidativo sejam importantes mediadores de varias formas de lesão renal aguda, como insuficiência renal isquêmica, nefrotoxicidade por contraste e obstrução ureteral. O objetivo deste estudo é investigar os efeitos terapêuticos do antioxidante N-acetilcisteína na evolução precoce de receptores de transplante renal de doador falecido quanto à função do enxerto e ao estresse oxidativo. MÉTODO Entre abril de 2005 e junho de 2008, 74 receptores adultos de primeiro transplante renal de doador falecido foram distribuídos aleatoriamente em grupo tratado com N-acetilcisteína (n=38) ou controle (n=36) e avaliados prospectivamente por 90 dias. O grupo tratado com N-acetilcisteína (NAC) recebeu 600 mg por via oral, em duas tomadas diárias, por 7 dias, iniciado no dia do trasplante. A rejeição aguda comprovada por biópsia foi avaliada em até 30 dias de pós-operatório (PO). A função renal foi determinada por dosagem de creatinina sérica, cálculo do clearance de creatinina pela fórmula de Cockroft-Gault no 7º, 15º, 30º, 60º e 90º PO e comparação de número de dias em diálise ao longo do tempo após o transplante através de estimativa de Kaplan-Meier. A dosagem de substâncias reativas de ácido tiobarbitúrico (TBARS), que são marcadores de peroxidação lipídica e estresse oxidativo, foi determinada do 0-7º PO. A análise estatística foi realizada com auxílio do SPSS 16.0 e Qui-quadrado, teste exato de Fisher, teste t de Student, teste Mann-Whitney, ANOVA e teste log rank foram aplicados conforme indicado. RESULTADOS A rejeição aguda comprovada por biópsia foi menos freqüente, embora não significativa (p=0,203), entre os pacientes tratados com NAC (3/38 7,9% vs. 7/36 19,4%). O grupo tratado com NAC apresentou uma menor creatinina média durante o seguimento (p=0,026). A depuração de creatinina calculada foi maior para o grupo NAC (p=0,029). O número de dias em diálise de receptores ao longo do tempo após o transplante foi menor no grupo tratado com NAC (p=0,008). O estresse oxidativo foi significantemente reduzido (p<0,001) com NAC até o 7º PO. CONCLUSÃO A N-acetilcisteína melhorou a evolução precoce dos pacientes submetidos a transplante renal de doador falecido pela recuperação mais rápida e mantida da função renal, através da atenuação do estresse oxidativo / INTRODUCTION Deceased renal transplant graft survival rates are worse than those from living donors. Reactive oxygen metabolites are believed to be important mediators of various forms of acute kidney injury, such as ischaemic renal failure, radiocontrast nephrotoxicity and ureteral obstruction. The aim of this study is to investigate the therapeutic effects of the antioxidant N-acetylcysteine (NAC) on early outcomes of deceased renal transplant patients regarding graft function and oxidative stress. METHOD Between April 2005 and June 2008, 74 adult primary graft recipients of deceased renal donors were randomly assigned to treatment (NAC) (n=38) or control (n=36) group and prospectively evaluated for 90 days. Treatment group received N-acetylcysteine 600 mg bid po from 0 to 7th postoperative day (PO). Renal function was determined by serum creatinine, Cockroft-Gault estimated GFR (eGFR) at 7th, 15th, 30th, 60th and 90th PO and dialysis free Kaplan-Meier estimate curve. Serum levels of thiobarbituric acid reactive substances (TBARS), which are markers of lipid peroxidation and oxidative stress, were determined using the thiobarbituric acid assay from 0-7th PO. Statistical analysis was performed using SPSS 16.0 and Chi-square test, Fisher´s exact test, Student t test, Mann-Whitney test, ANOVA and log rank test were applied as indicated. RESULTS Biopsy confirmed acute rejection was less frequent, albeit not significant, with NAC (3/38 7.9% vs. 7/36 19.4%, p=0.203). NAC group presented a lower mean serum creatinine during follow-up (p=0.026). NAC group presented a higher mean eGFR (p=0.029). Kaplan-Meier estimate for dialysis free recipients presented less days of dialysis for the NAC group (p=0.008). Oxidative stress was significantly attenuated with NAC (p<0.001). CONCLUSION Our results suggest that N-acetylcysteine enhance deceased renal transplant outcomes by attenuating oxidative stress

A obstrução intestinal mecânica representa uma condição de urgência, necessitando diagnóstico precoce e terapêutica adequada, em virtude do seu elevado grau de morbidade e de mortalidade. Desta forma, o objetivo deste estudo foi avaliar o efeito da N-acetilcisteína associada ao Ringer lactato ou à solução salina hipertônica na resposta inflamatória, histologia e translocação bacteriana em modelo experimental de obstrução e isquemia intestinal. Para tanto, Foram constituídos quatro grupos experimentais, com 10 ratos Wistar em cada, além do grupo de referência: OI - Submetidos a obstrução e isquemia intestinal e enterectomia com anastomose intestinal, sem reanimação volêmica; RL - Submetidos a obstrução e isquemia intestinal, reanimação volêmica com Ringer lactato (32ml/kg, i.v., em 10 minutos) e enterectomia com anastomose intestinal; RLNAC - Submetidos a obstrução e isquemia intestinal, reanimação volêmica com Ringer lactato associado a NAC (32ml/kg + 150 mg/kg i.v. em 10 minutos) e enterectomia com anastomose intestinal; SHNAC - Submetidos a obstrução e isquemia intestinal, reanimação volêmica com solução salina hipertônica a 7,5% associado com NAC (4ml/kg + 150 mg/kg i.v., em 10 minutos) e enterectomia com anastomose intestinal. Grupo Referência (n=5): Animais anestesiados, submetidos a coleta de materiais para cultura e histologia e sacrificados por exsanguinação. Os animais receberam uma associação anestésica de cetamina e xilazina intramuscular em membro posterior direito, na dose de 60mg/kg e 10mg/kg, respectivamente. Decorridas 24 h do tratamento, a eutanásia foi realizada por exanguinação, sob anestesia, após a coleta dos tecidos / Mechanical intestinal obstruction represents a condition of urgency, necessary early diagnosis and appropriate therapy, due to their high degree of morbidity and mortality. In this way, the objective of this study was to evaluate the effect of N-acetylcysteine associated with lactated Ringer\'s or hypertonic saline solution in the inflammatory response, histology and translocation in an experimental model of intestinal obstruction and ischemia. For Four experimental groups were constituted with 10 Wistar rats each, in addition to the reference group: OI - submitted to obstruction and ischemia intestinal and enterectomy with intestinal anastomosis, without volume resuscitation; RL - Undergoing intestinal obstruction and ischemia, volume resuscitation with Ringer\'s lactate (32ml / kg, i.v., within 10 minutes) and anastomosis enterectomy intestinal; RLNAC - Undergoing obstruction and intestinal ischemia, resuscitation with lactated Ringer\'s lactating NAC (32 ml / kg + 150 mg / kg i.v. in 10 minutes) and enterectomy with intestinal anastomosis; SHNAC - Submitted to obstruction and intestinal ischemia, volume resuscitation with saline solution hypertension at 7.5% associated with CAP (4 ml / kg + 150 mg / kg i.v., in 10 minutes) and enterectomy with intestinal anastomosis. Reference Group (n = 5): Anesthetized animals, submitted to collection of materials for culture and histology and sacrificed by exsanguination. The animals received a anesthetic association of ketamine and intramuscular xylazine in limb posterior right, at the dose of 60mg / kg and 10mg / kg, respectively. After 24 h of treatment, euthanasia was performed by exsanguination, under anesthesia, after collection of tissues

Orientador: Wilma De Grava Kempinas / Texto em português e inglês / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-24T16:12:27Z (GMT). No. of bitstreams: 1 Silva_RaquelFrenedoso_M.pdf: 3492189 bytes, checksum: 66cf94f64336b7c79f7b1cf8981d8d60 (MD5) Previous issue date: 2014 / Resumo: O trióxido de arsênio (As2O3) tem se mostrado altamente eficaz e muito utilizado no tratamento para diminuir ou eliminar a leucemia promielocítica aguda. Estudos mostram relação entre exposição a este composto e inibição da espermatogênese ou desenvolvimento do espermatozoide, uma vez que exerce efeito inibitório nos testículos. Diante da crescente utilização do As2O3 no tratamento da leucemia e da escassez de resultados sobre os seus efeitos adversos na reprodução masculina, justifica-se a realização do presente estudo, pelo qual se avaliou os efeitos imediatos e tardios do tratamento com As2O3 sobre fisiologia reprodutiva de camundongos Swiss adultos e se a co-administração de N-acetilcisteína (NAC), previne esses efeitos. Em um primeiro experimento, camundongos Swiss adultos foram tratados com veículo, 0,3 ou 3,0 mg/Kg/dia de As2O3, via subcutânea, em 25 aplicações. No final do tratamento, metade dos animais foram eutanasiados para avaliação dos efeitos pós-tratamento e a outra metade foi mantida sem a droga por período de 50 dias, até que se procedeu a eutanasia para avaliação da possível reversibilidade dos efeitos. Foram investigados: peso dos órgãos vitais, reprodutores e glândulas sexuais acessórias, quantidade e qualidade espermáticas, dosagem de testosterona e dosagem de arsênio no sangue. Os animais tratados com 3,0 mg/kg de As2O3 e eutanasiados logo após o fim do tratamento mostraram diminuição no peso da vesícula seminal, número de espermatozoides móveis e produção espermática diária. Após período de suspensão do tratamento, os animais tratados com a mesma dose continuaram apresentando redução nos mesmos parâmetros. Em um segundo experimento, foi avaliada a contratilidade do ducto epididimário isolado tanto frente ao tratamento in vivo dos animais (tratados com o veículo ou com a dose de 3,0 mg/kg/dia de As2O3) quanto ao tratamento in vitro do tecido. Essa análise revelou que a contração máxima do ducto epididimário estava significativamente aumentada nos animais tratados com As2O3 in vivo. E em uma terceira etapa os animais foram divididos em Controle, As2O3 (3,0 mg/Kg/dia), NAC na água de beber (40mM) e As2O3 + NAC, tratados por 5 semanas. Após o final do tratamento, os animais foram avaliados quanto aos parâmetros que se apresentaram prejudicados com o tratamento anterior, descrito na etapa um. Quando a NAC foi oferecida aos animais, houve uma melhora significativa nos parâmetros espermáticos antes prejudicados pela administração da droga, i.e., o peso de vesícula seminal, número de espermatozoides móveis e produção espermática diária do grupo As2O3 + NAC foram similares ao grupo controle. Podemos concluir que o As2O3 exerce efeitos tóxicos sobre o sistema genital de camundongos machos, e que esses efeitos podem ser persistentes mesmo após o término do tratamento. Os resultados mostraram, também, que a administração de um antioxidante pode prevenir os efeitos deletérios dessa droga sobre os parâmetros avaliados / Abstract: Arsenic trioxide (As2O3), a trivalent arsenic form has proven highly effective and widely used in the treatment to reduce or eliminate acute promyelocytic leukemia. Studies show a relationship between exposure to this compound and inhibition of spermatogenesis and sperm development since it exerts an inhibitory effect on the testis. Given the growing use of As2O3 on treatment of leukemia and the lack of results about the side effects on male reproduction, it is justified to carry out this study, which evaluated the immediate and late effects of treatment with As2O3 on the structure and reproductive physiology of adult Swiss mice and whether the co-administration of N-acetylcysteine (NAC) prevents these effects. In a first experiment, adult Swiss mice were treated with vehicle, 0.3 or 3.0 mg/Kg/day of As2O3, subcutaneously in 25 applications. At the end of treatment, half of the animals were euthanized for evaluation of the post- treatment effects and the other half was maintained without the drug for 50 days until the euthanasia to evaluate the potential reversibility of the effects. It was evaluated: the vital, reproductive and accessories organ weights, analyzes of sperm quantity and quality, testosterone and arsenic measurements in blood. Animals treated with 3.0 mg/Kg of As2O3 and euthanized immediately after the end of treatment showed a decrease of seminal vesicle weight, in number of motile spermatozoa and daily sperm production. After suspension of treatment, animals treated with this same dose continued to show reduction in these same parameters. In a second experiment, the contractility of the epididymal duct was evaluated both in vivo treatment of animals (treated with vehicle or a 3.0 mg/Kg/day of As2O3) and in vitro treatment of the tissues. This analysis revealed that the maximum contraction of the epididymal duct was significantly increased in in vivo treated animals. And in a third step animals were divided into Control, As2O3 (3.0 mg/Kg/day) NAC in tap water (40 mM) and As2O3 + NAC, treated for 5 weeks. After the end of treatment, animals were assessed for previously impaired parameters described in step one. When NAC was given to the animals, there was a significant improvement in sperm parameters before harmed by the drug administration, i.e. seminal vesicle weight, number of motile sperm and daily sperm production in As2O3 + NAC group were similar to the control group. We conclude that As2O3 exerts toxic effects on the male mice genital system, and that these effects may be persistent even after the end of treatment. Also, the results showed that administration of an antioxidant can prevent the deleterious effects of this drug on the parameters evaluated / Mestrado / Biologia Celular / Mestra em Biologia Celular e Estrutural

Na infecção pelo HIV o equilíbrio entre antioxidantes e pró-oxidantes e a produção de citocinas encontram-se alterados, causando estresse oxidativo crônico. Presume-se que o estresse oxidativo crônico e a ativação do sistema imunológico favorecem a replicação do vírus através da ativação do NF-kB e a apoptose de células mononucleares do sangue periférico. O objetivo deste estudo foi avaliar o efeito da suplementação, durante 180 dias, com 600mg/dia de N-acetilcisteína (NAC), sobre a carga viral, os níveis de sub-populações de linfócitos, a viabilidade de linfócitos e sobre os níveis séricos de citocinas, proteínas, lipídeos, &#946;2 microglobulina e outros marcadores da ativação do sistema imunológico em pacientes assintomáticos, submetidos ao primeiro tratamento anti-retroviral. Participaram deste estudo, duplo cego controlado por placebo, que teve a duração de 180 dias, 30 indivíduos que iniciaram a terapia anti-retroviral. O grupo estudo foi constituído por 14 indivíduos que além do tratamento anti-retroviral foram suplementados com NAC, enquanto o grupo controle foi constituído por 16 indivíduos que além do tratamento anti-retroviral receberam placebo. Os marcadores avaliados foram determinados no dia anterior ao início do tratamento a que foram submetidos e após 60, 120 e 180 dias. Verificou-se aumento significante dos linfócitos CD4+, da relação CD4/CD8, de linfócitos viáveis, albumina, cisteína e glutationa, bem como diminuição significante dos níveis de TNF-&#945;, IL-8, haptoglobina e &#945;1-glicoproteína ácida, &#946;2-microglobulina, IgA e IgM, nos dois grupos estudados. Os níveis séricos de IL-6, colesterol total, LDL-colesterol, VLDL-colesterol e triglicerídeos não apresentaram alteração significante ao final deste estudo. Concluindo, a suplementação com 600 mg/dia de NAC, em pacientes submetidos ao tratamento anti-retroviral, não proporcionou benefícios adicionais àqueles decorrentes deste tratamento. / In HIV infection, the balance between antioxidants and pró-oxidants and the production of citokines are disturbed leading to a chronic state of oxidative stress and immune activation. It is presumed that HIV takes advantage of the proinflammatory and prooxidative environment to replicate through the NF-kB pathway leading to the apoptosis of peripheral blood mononuc1ear cells. The aim of this work was to study the effect of oral administration of N-acetylcysteine (NAC) 600 mg per day during 180 days on viral load, viability of lymphocytes, cytokines, proteins, lipids, &#946;2-microglobulin and other immune activation markers in asymptomatic patients under their first antiretroviral therapy. This was a double-blind, placebo-controlled study with 30 individuals who started antiretroviral therapy and were followed for 180 days. These individual were divided into two subgroups: the study group consisted of 14 participants who received NAC supplementation, whereas the control group had 16 individuals who received placebo. The studied markers were determined on the day before the beginning of treatment and after 60, 120 and 180 days of treatment. A significant increase was seen for CD4+ lymphocytes, the CD4/CD8 ratio, albumin, cysteine and glutathione; also, a significant reduction was found for levels of TNF-&#945;, IL-8, &#946;2 microglobulin, IgA, IgG, IgM, haptoglobin, and acid &#945;1-glycoprotein as a consequence of antiretroviral treatment. After 180 days of treatment, the levels of total protein, globulins and HDL-cholesterol presented significant alteration on1y in the control group, while the serum levels of IL-6, total cholesterol, LDL-cholesterol, VLDL-cholesterol and triglyceride did not show significant alteration at the end of the present study. In conclusion, the supplementation of HIV-positive patients with 600 mg/day of NAC did not bring additional benefits to those resulting from antiretroviral treatment.

Outre son role majeur dans la resistance cellulaire au stress oxydant, le tripeptide glutathion (L-ƒÁ glutamyl- cysteinyl-glycine) est essentiel a la survie cellulaire. Un deficit en glutathion, associe a un stress oxydant, est un trait commun a plusieurs maladies chroniques inflammatoires et degeneratives. Dans le cadre de ces differentes pathologies, plusieurs etudes ont montre que la prise orale de N-acetylcysteine (NAC), un precurseur de glutathion, ameliorait l'etat des patients. Le stress oxydant et l'inflammation sont deux caracteristiques principales de l'insuffisance cardiaque et des dystrophies musculaires. Nous avons pose l'hypothese d'un deficit en glutathion dans ces maladies et les benefices possibles d'un traitement par le NAC. Dans le modele du rat developpant une insuffisance cardiaque post-infarctus, nous montrons qu'il existe un deficit en glutathion tissulaire. Un mois de traitement oral par le NAC, donne en curatif post-infarctus, restaure le taux de glutathion cardiaque, reduit le stress oxydant, et interrompt le cycle vicieux inflammation/mort cellulaire, TNF/TNF-R1/NSMase/ caspase-3/apoptose. Un deficit en glutathion systemique et tissulaire caracterise aussi les souris LmnaH222P/H222P de 6-7 mois developpant une cardiomyopathie dilatee, modele de la cardiomyopathie associee a la dystrophie musculaire dfEmery Dreifuss. Un mois de traitement oral par le NAC reduit chez les souris de 7 mois la dilatation ventriculaire gauche et la dysfonction contractile, limite la progression de la fibrose cardiaque et lfinflammation. Ceci est associe a une repletion en glutathion et une normalisation de l'expression des enzymes du metabolisme du glutathion, a une diminution du stress oxydant et de l'expression du TNF. Une premiere etude chez les patients de chirurgie cardiaque (n=91) nous a permis de mettre en evidence que : d'une part, il existait un deficit en glutathion auriculaire chez les patients de la classe NYHA IV compares aux patients de la classe NYHA I. D'autre part, les patients asymptomatiques (classe NYHA I) presentaient un deficit en glutathion sanguin, compares aux individus sains, aggrave chez les patients symptomatiques (classes NYHA II a IV). Le deficit en glutathion sanguin chez les patients asymptomatiques precede lfelevation du taux sanguin de TNFR1, un marqueur standard du degre de severite de l'insuffisance cardiaque. Une seconde etude, chez des patients porteurs dfune mutation de la lamine (n=28) et susceptibles de developper une cardiomyopathie dilatee d'Emery Dreifuss, montre que certains de ces patients presentent un deficit en glutathion sanguin, associe chez un seul de ces patients a un taux eleve de TNFR1. L'analyse comparee des donnees biochimiques et cliniques est en cours. Les souris DMDmdx4cv sont un modele experimental de la dystrophie musculaire de Duchenne (DMD), mais ne developpent que tardivement la maladie cardiaque. Nous observons une augmentation du taux du glutathion systemique chez les souris de plus de 10 semaines. Un traitement oral avec un inhibiteur de synthese du glutathion a faible dose, le Lbuthionine sulfoximine (5 mM BSO), ramene le taux de glutathion systemique chez la souris DMDmdx4cv au taux chez la souris sauvage, mais provoque des alterations des cardiomyocytes identifiees par immunohistochimie, des micronecroses, des anomalies de capillaires et des anomalies mitochondriales observees en microscopie electronique. En conclusion, le deficit en glutathion est un evenement precoce et durable au cours de l'insuffisance cardiaque, d'origine ischemique ou genetique. Les perspectives offertes par ces resultats sont: 1) le test du glutathion sanguin pour le depistage de sujets asymptomatiques a risque; 2) l'indication de NAC aux patients cardiaques, en complement du traitement courant / The tripeptide glutathione (L-? -glutamyl-cysteinyl-glycine) does not only play a major in cellular resistance to oxidative stress, but is also essential to cell survival. A deficit in glutathione, associated with oxidative stress, is a common hallmark of several chronic inflammatory and neurodegenerative diseases. In different examples, several studies reported that oral treatment with N-acetylcysteine (NAC), a glutathione precursor, improved patient status. Oxidative stress and inflammation are two main characteristics of heart failure (HF) and muscular dystrophy. We hypothesized that glutathione deficiency occurred in these diseases and that treatment with NAC might be beneficial. In post-myocardial infarction (MI) rats, with established chronic HF, we show that cardiac tissue is depleted in glutathione. Curative 1-month oral NAC treatment replenishes cardiac tissue glutathione, reduces oxidative stress and disrupts the vicious inflammation/cell death, TNF/TNF-R1/N-SMase/ caspase-3/ apoptosis cycle. Deficit in serum and cardiac glutathione also characterize 6- to 7-month old LmnaH222P/H222P mice with dilated cardiomyopathy (DCM), a model of the cardiomyopathy associated with Emery Dreifuss muscular dystrophy (EDMD), One-month oral NAC treatment reduces left ventricular dilation and contractile dysfunction, limits the progression of cardiac fibrosis and inflammation in 7-month old LmnaH222P/H222P mice. This is associated with glutathione repletion and normalization of glutathione metabolism enzymes, and reduction of oxidative stress and TNF expression. In a first study in cardiac surgery patients (n=91) we show that: on the one hand, atrial glutathione is depleted in patients of NYHA class IV compared with asymptomatic patients of NYHA class I. On the other hand, asymptomatic patients of NYHA class display a deficiency in blood glutathione compared with healthy controls that worsens in asymptomatic patients of NYHA class II-IV. Blood glutathione deficiency in asymptomatic patients precedes elevation of blood TNFR1, a standard marker of HF severity. A second study, in patients with lamin mutation (n=28), prone to develop an Emery Dreifuss DCM, shows that a number of patients display blood glutathione deficiency, with one patient having a high blood TNFR1 level. Analysis of clinical data is underway. DMDmdx4cv mice are an experimental model of Duchenne muscular dystrophy. We observe an increase in blood glutathione in 10-week-old mice and older. Oral treatment with a low dose of L-buthionine sulfoximine (5 mM BSO), an inhibitor of glutathione synthesis, resumes blood glutathione in DMDmdx4cv mice to the control value in WT mice, but produces alterations in cardiomyocytes identified by immunohistochemistry and micronecrosis, capillary and mitochondrial abnormalities observed by electronic microscopy. In conclusion, glutathione deficiency is an early and lasting event in ischemic or genetically-linked HF. These results pave the way for two possible applications: 1) blood glutathione test for the screening of asymptomatic individuals at risk for HF; 2) NAC indication to cardiac patients in addition to current treatment

Background: There is robust preclinical literature and preliminary clinical findings supporting the use of N-Acetylcysteine (NAC) to treat substance use disorders, including tobacco use disorder (TUD). However, randomized controlled trials have yielded mixed results and NAC's efficacy for TUD has not been established. The goals of this study were to assess the efficacy of NAC in promoting early and end-of-treatment abstinence and preventing relapse among adult smokers. Methods: This randomized, double-blinded clinical trial enrolled adult, daily smokers (N = 114; ages 23–64; 51 % female; 65 % White; 29 % Black/African American; 7% Hispanic/Latinx), who were randomized 1:1 to receive NAC (n = 59) or placebo (n = 55) (1200 mg b.i.d.) for eight weeks. Participants received brief cessation counseling and incentives for abstinence during the first three days of the quit attempt. Primary outcomes: (i) carbon monoxide (CO)-confirmed abstinence during the first three days of the quit attempt. Secondary outcomes: (ii) time to relapse; (iii) biologically confirmed abstinence at Week 8. Results: No differences were found between NAC and placebo groups on measures of early abstinence (3-day quit attempt; 11 % for NAC vs. 15 % for placebo; all p > 0.11), time to relapse (p = 0.19), and end-of-treatment abstinence (7% for NAC vs. 11 % for placebo; all p > 0.40]. Conclusions: Results indicate that NAC is a well-tolerated pharmacotherapy but is unlikely to be efficacious as a monotherapy for TUD in adults. Considered in the collective context of other research, NAC may potentially be more useful in a younger population, as a combination pharmacotherapy, or in the presence of more intensive psychosocial treatment.

What is known and objective: Amiodarone, a commonly used class III antiarrhythmic agent notable for a relatively long half-life of up to 6 months and its pronounced adverse effect profile, is used for both acute and chronic management of cardiac arrhythmias. Chronic use of amiodarone has been associated with asymptomatic hepatotoxicity; however, acute toxicity is thought to be uncommon. There are only six reported cases of acute liver failure (ALF) secondary to amiodarone. In all these cases the outcome of death during the same hospitalization resulted. We aimed to report the only case of acute liver failure secondary to amiodarone infusion in the existing literature where the patient survived. Case summary: A 79-year-old woman admitted with atrial flutter was being treated with intravenous (IV) amiodarone when she abruptly developed coagulopathy, altered mental status and liver enzyme derangement. She was diagnosed with acute liver failure (ALF) secondary to an amiodarone adverse drug reaction, with a calculated score of seven on the Naranjo adverse drug reaction probability scale. Amiodarone was immediately withheld, and N-acetylcysteine (NAC) was initiated. Clinical improvement was seen within 48 hours of holding the drug and within 24 hours of initiating NAC. On post-hospital follow-up visit she was reported to have complete recovery. What is new and conclusion: This report emphasizes the importance of monitoring liver enzymes and mental status while a patient is being administered IV amiodarone. N-acetylcysteine administration may have possibly contributed to the early and successful recovery from ALF in our patient. To date, she is the only patient in the existing literature who has been reported to survive ALF secondary to amiodarone administration.

Diss. (sammanfattning) Umeå : Umeå universitet, 2010.

Inledning: Jodkontrastmedel är ett läkemedel som administreras av röntgensjuksköterskan för att förbättra kontrasten mellan inre organ och vävnader samt skilja mellan normala och patologiska områden. Jodkontrastmedel gavs uppskattningsvis i 80 miljoner doser över hela världen år 2003. Av kontrastmedel kan allvarlig biverkning eller till och med ett livshotandetillstånd uppkomma som kontrastmedelsinducerad nefropati (KMN). N-Acetylcystein (NAC) har flera egenskaper, bland annat antioxidfunktioner och förbättring av njurarnas perfusion som kan vara bidragande egenskaper till att förebygga KMN. Syfte: Denna litteraturöversikt var att sammanställa om N-Acetylcystein (NAC) är ett effektivt hydreringsalternativ för att förebygga kontrastmedelsinducerad nefropati (KMN) Metod: Studien utfördes som en allmänlitteraturöversikt. Tio vetenskapliga artiklar kvalitetsgranskades, analyserades och resultatet presenterades i kategorier. Resultat: Analysen av tio artiklar resulterade i sex kategorier, om NAC har en bra hydrerande effekt mot KMN, högriskpatienternas utveckling av KMN och NAC:s effekt, kontrastmedelsdos, mätvärden kontrollerade med serumkreatinin och cystatin C, biverkningar från oral och intravenös administration av NAC samt studiernas definition på KMN. Slutsats: NAC tillsammans med hydrering har visat sig i vissa studier vara effektivt mot KMN men det är ändå oklart om det är NAC som ger den positiva effekten. NAC tillsammans med hydrering verkar inte ge några negativa effekter för patienten då NAC har få biverkningar och är ett billigt läkemedel, men röntgensjuksköterskan bör ge kontrastmedelsdos enligt uträknad GFR. / Introduction: Iodine contrast media is a drug that is administered by the radiographer to enhance the contrast between the internal organs and tissues and distinguish between normal and pathological areas. Iodine contrast media is given estimated to 80 million dosesworldwide year 2003. By contrast media, a serious side effect or even a life-threatening condition can arise like contrast induced nephropathy (CIN). N-Acetylcysteine (NAC) has acapacity of antioxidant functions and improvement of renal perfusion, which may be properties to help and prevent CIN. Purpose: This literature review was to compile if N-Acetylcysteine (NAC) is an effective hydrations alternative to prevent contrast induced nephropathy (CIN) Method: The study was conducted as a general literature review. Tenquality scientific articles were reviewed, analyzed and the results were presented in categories. Results: The analysis of the ten articles resulted in six categories, the NAC has a good dehydrating effect against KMN, high-risk patients, the development of KMN and NAC:s effect, contrast media, measurements controlled by serum creatinine and cystatin C, side effects from oral and intravenous administration of NAC and studies definition of KMN Conclusions: NAC with hydration has been shown in some studies to be effective against KMN but it is still unclear whether it is NAC that gives the positive effect. We believe that NAC along with hydration do not hurt to give to the patient when the NAC has few side effects and is an inexpensive drug, but radiographer should give contrast media according to calculated GFR.

Orientador: Ewerton Garcia de Oliveira Mima / Resumo: Candida albicans (Ca) é o principal fungo patógeno humano, responsável por infecções como a candidose orofaríngea e a candidemia. Essas infecções estão fortemente associadas com a formação de biofilmes. O uso abusivo de antifúngicos tem levado ao desenvolvimento de resistência fúngica. As terapias direcionadas aos biofilmes, principalmente contra a matriz extracelular (MEC), são relevantes para o desenvolvimento de novos tratamentos mais eficazes. Um dos agentes que tem demonstrado ação antibiofilme é a N-acetilcisteína (NAC). Assim, o objetivo deste estudo foi avaliar a ação da NAC em biofilmes in vitro de C. albicans susceptível (CaS) e resistente ao fluconazol (CaR). Culturas planctônicas de CaS e CaR foram cultivadas e submetidas ao teste de susceptilidade à NAC. Foram determinadas também a curva de inativação de ambas as cepas sob ação da NAC, seu efeito na formação do biofilme e no biofilme maduro. Por fim, foi avaliada a ação NAC na composição da MEC do biofilme, por meio da quantificação de peso seco total e do precipitado, polissacarídeos solúveis em água (WSP) e álcali (ASP), proteínas do sobrenadante e do precipitado e DNA extracelular (eDNA). Os dados obtidos foram analisados descritivamente e pelos testes ANOVA/Welch e Tukey/Gomes-Howell ou Kruskal-Wallis (=0,05). A concentração inibitória mínima da NAC com redução de 90% (CIM90) foi de 25 mg/mL para ambas as cepas. Apesar de não ter sido encontrado nenhum valor de concentração fungicida mínima (CFM), a NAC redu... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Candida albicans is the main fungal pathogen in humans, responsable for local and systemic infections, such as oropharyngeal candidiasis and candidemia. These fungal infections are associated with biofilm formation. The abusive use of antifungals has led to the development of fungal resistance. The therapies towards the biofilms, mainly against the matrix, are relevant for the development of more effective new treatments. One of the agents that have demonstrated antibiofilm action is N-acetylcysteine (NAC). Therefore, the aim of this study was to evaluate the effect in vitro of NAC on biofilms of C. albicans susceptible (CaS) and resistant to fluconazole (CaR). CaS and CaR were submitted to the susceptibility test to NAC. The time-kill curves of NAC and its effect on biofilm formation and mature biofilms were also determined for both strains. Finally, the effect of NAC on the composition of the biofilms matrix was evaluated [total and pellets’s dry weight, water (WSP) and alkali soluble polysaccharides (ASP), supernatant and pellet’s proteins, and extracellular DNA (eDNA)]. The data were descriptively analyzed and submitted to the ANOVA/Welch and Tukey/Gomes-Howell or Kruskal-Wallis tests (= 0.05). The minimum inhibitory concentration of NAC with 90% of reduction (MIC90) was 25 mg/mL. Although no minimum fungicidal concentration (MFC) value was found, NAC reduced (p≤ 0,001) the fungal viability by 1.81 to 4.06 log10 for both strains. In the time-kill curves, only concentrati... (Complete abstract click electronic access below) / Mestre