Objetivo: Determinar la incidencia de Coagulación Intravascular diseminada(CID), en el Instituto Materno Perinatal de Lima, durante el periodo 1999-2001 Diseño: Estudio observacional, retrospectivo, longitudinal y analítico, se revisaron 55 Historias Clínicas de pacientes de la Unidad de Cuidados Intensivos del IMP, con el diagnóstico de CID, en el periodo de Enero de 1999 a Diciembre del 2001, que cumplieron con los criterios de inclusión. Resultados: La incidencia de CID fue 0.04%(7.7 casos /año), la edad más frecuente en la que se presentó fue entre los 20-29 años(43.48%), fue más frecuente entre los 37-41 semanas de gestación(39.13 %), más frecuente en multigestas (45%), los signos más frecuentes relacionado a CID fueron sangrado vaginal(65.22%) y sangrado en napa por la herida operatoria(56.52%), el principal factor de riesgo asociado fue el desprendimiento prematuro de placenta (47.83), el 56.52% no tuvo controles prenatales, el principal antecedente materno fue la multiparidad,(47.83%), en su mayoría la vía de termino de la gestación fue la cesárea(69.55%),La mortalidad materna fue elevada (13%), la mortalidad perinatal llegó a 43.48%, dentro de los exámenes auxiliares el 69.57 % tuvo rangos de fibrinógeno entre 50-100 mg/dl y recuento de plaquetas entre 51,000 y 100,000/ml(65.22%). Conclusión: La CID tiene una elevada mobimortalidad materno perinatal.

Pulmonary intravascular macrophages (PIMs) promote lung inflammation and are found in ruminants, horses, pigs, cats, and dolphins, but not in primates, rats and mice. Rabbits are used to study mechanisms of lung inflammation in humans, but disagreement exists whether rabbits have PIMs. This study examined rabbits for PIMs, and their influence on endotoxin-induced lung inflammation.<p> Rabbits were treated with gadolinium chloride (10 mg/kg intravenous: Group GC, n=6) to produce apoptosis in PIMs, or with saline (Group SAL, n=6). Rabbits were euthanized 48 hours later. Light microscopic examination of epoxy-embedded rabbit lung sections revealed mononuclear phagocytes in alveolar septa. Transmission electron microscopy confirmed PIMs with lysosomes and close attachment to capillary endothelium. Light microscopic immuno-cytochemistry using rabbit anti-macrophage antibody (RAM-11) showed staining of septal and alveolar macrophages. There was no difference in number of RAM-11 positive septal cells between SAL and GC rabbits (P=0.2).<p> Rabbits were administered intravenous E.coli 0127:B8 endotoxin (100 Ýg/kg) 48 hours after GC (GC-LPS; n=5) or SAL treatment (SAL-LPS; n=6), and euthanized 24 hours later. Rabbits in both LPS treated groups were hypocalcaemic and exhibited compensated metabolic acidosis compared to SAL rabbits. Four rabbits died in the SAL-LPS group within 24 hours of the endotoxin treatment and were replaced. None died in the GC-LPS group (Chi-square comparison for survival P=0.063). Greater numbers of septal heterophils were found in groups SAL-LPS and GC-LPS compared to SAL and GC. TNFÑ protein in serum, and IL-1Ò and IL-6 mRNA in lung tissues were increased in SAL-LPS compared to SAL and GC rabbits. Lung tissues from SAL-LPS rabbits but not in GC-LPS showed moderate inflammation, but lung wet/dry ratios were not different. Lung tissue TNFÑ, IL-1Ònand IL-6 mRNA, myeloperoxidase activity, and serum TNFÑ were reduced in GC-LPS animals compared to SAL-LPS. Immuno-electron microscopy revealed TNFÑ in PIMs in normal and LPS-treated rabbits. Lung and liver tissue TNFÑ, IL-8 and MCP-1 protein concentrations were not different between groups. GC did not appear to reduce liver inflammation. These data show that rabbits have low numbers of PIMs. GC treatment induced apoptosis in PIMs and reduced endotoxin-induced lung inflammation and mortality.

Pulmonary intravascular macrophages (PIMs) promote lung inflammation and are found in ruminants, horses, pigs, cats, and dolphins, but not in primates, rats and mice. Rabbits are used to study mechanisms of lung inflammation in humans, but disagreement exists whether rabbits have PIMs. This study examined rabbits for PIMs, and their influence on endotoxin-induced lung inflammation.<p> Rabbits were treated with gadolinium chloride (10 mg/kg intravenous: Group GC, n=6) to produce apoptosis in PIMs, or with saline (Group SAL, n=6). Rabbits were euthanized 48 hours later. Light microscopic examination of epoxy-embedded rabbit lung sections revealed mononuclear phagocytes in alveolar septa. Transmission electron microscopy confirmed PIMs with lysosomes and close attachment to capillary endothelium. Light microscopic immuno-cytochemistry using rabbit anti-macrophage antibody (RAM-11) showed staining of septal and alveolar macrophages. There was no difference in number of RAM-11 positive septal cells between SAL and GC rabbits (P=0.2).<p> Rabbits were administered intravenous E.coli 0127:B8 endotoxin (100 Ýg/kg) 48 hours after GC (GC-LPS; n=5) or SAL treatment (SAL-LPS; n=6), and euthanized 24 hours later. Rabbits in both LPS treated groups were hypocalcaemic and exhibited compensated metabolic acidosis compared to SAL rabbits. Four rabbits died in the SAL-LPS group within 24 hours of the endotoxin treatment and were replaced. None died in the GC-LPS group (Chi-square comparison for survival P=0.063). Greater numbers of septal heterophils were found in groups SAL-LPS and GC-LPS compared to SAL and GC. TNFÑ protein in serum, and IL-1Ò and IL-6 mRNA in lung tissues were increased in SAL-LPS compared to SAL and GC rabbits. Lung tissues from SAL-LPS rabbits but not in GC-LPS showed moderate inflammation, but lung wet/dry ratios were not different. Lung tissue TNFÑ, IL-1Ònand IL-6 mRNA, myeloperoxidase activity, and serum TNFÑ were reduced in GC-LPS animals compared to SAL-LPS. Immuno-electron microscopy revealed TNFÑ in PIMs in normal and LPS-treated rabbits. Lung and liver tissue TNFÑ, IL-8 and MCP-1 protein concentrations were not different between groups. GC did not appear to reduce liver inflammation. These data show that rabbits have low numbers of PIMs. GC treatment induced apoptosis in PIMs and reduced endotoxin-induced lung inflammation and mortality.

Objetivo: Determinar la incidencia de Coagulación Intravascular diseminada(CID), en el Instituto Materno Perinatal de Lima, durante el periodo 1999-2001 Diseño: Estudio observacional, retrospectivo, longitudinal y analítico, se revisaron 55 Historias Clínicas de pacientes de la Unidad de Cuidados Intensivos del IMP, con el diagnóstico de CID, en el periodo de Enero de 1999 a Diciembre del 2001, que cumplieron con los criterios de inclusión. Resultados: La incidencia de CID fue 0.04%(7.7 casos /año), la edad más frecuente en la que se presentó fue entre los 20-29 años(43.48%), fue más frecuente entre los 37-41 semanas de gestación(39.13 %), más frecuente en multigestas (45%), los signos más frecuentes relacionado a CID fueron sangrado vaginal(65.22%) y sangrado en napa por la herida operatoria(56.52%), el principal factor de riesgo asociado fue el desprendimiento prematuro de placenta (47.83), el 56.52% no tuvo controles prenatales, el principal antecedente materno fue la multiparidad,(47.83%), en su mayoría la vía de termino de la gestación fue la cesárea(69.55%),La mortalidad materna fue elevada (13%), la mortalidad perinatal llegó a 43.48%, dentro de los exámenes auxiliares el 69.57 % tuvo rangos de fibrinógeno entre 50-100 mg/dl y recuento de plaquetas entre 51,000 y 100,000/ml(65.22%). Conclusión: La CID tiene una elevada mobimortalidad materno perinatal.

The primary focus of the work was to evaluate the capability of intravascular photoacoustic (IVPA) imaging in combination with intravascular ultrasound (IVUS) to detect and differentiate atherosclerotic plaques. The composition rather than structural narrowing of the arteries is a major indicator of the propensity of a vascular lesion to rupture. Consequently, intravascular imaging of these high-risk plaques is required to exactly determine the vulnerable plaque constituents for appropriate follow-up therapy. Our multi-modality imaging approach aims to utilize the high resolution structural assessment abilities of IVUS and the optical contrast of IVPA imaging and is capable of differentiating the lipid, fibrous and fibro-cellular components of an inflammatory lesion. To test the hypothesis, we developed an IVUS catheter based laboratory prototype of a combined IVUS/IVPA imaging system. The performance of the synergistic combination of IVUS and IVPA imaging was evaluated through tissue mimicking phantom studies. Further, to test the ability of the combined imaging to detect plaques, excised samples of an aorta were utilized from a specifically designed animal model of atherosclerosis. Ex-vivo IVPA imaging studies were performed using a 532 nm laser excitation to detect the lipids in the plaque. In addition, multi-wavelength spectroscopic IVPA imaging studies were evaluated to differentiate plaques. Finally, an ultrasound based temperature estimation method was utilized to demonstrate and confirm safety of IVPA imaging for clinical intravascular applications. Upon analysis of the results of our investigation, we believe that IVPA imaging offer numerous potential advantages when integrated with clinical IVUS imaging. The IVUS imaging system with integrated IVPA imaging capability could play a major role in interventional cardiology. / text

Thesis (Ph. D.)--University of Texas at Austin, 2007. / Vita. Includes bibliographical references.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Bedside ultrasound of the inferior vena cava (IVC) has grown to be an important tool in the assessment and management of critically ill patients. This study endeavors to examine which location along the IVC is most highly correlated with changes in intravascular volume status: (1) the diaphragmatic juncture (DJ) (2) two centimeters caudal to the hepatic vein juncture (2HVJ) or (3) left renal vein juncture (LRVJ). Data was collected in this prospective observational study on patients in the emergency department who were at least 16 years of age, being treated with intravenous fluids (IVF). Measurements of the IVC were recorded at each site during standard inspiratory and expiratory cycles, and again with the patient actively sniffing to decrease intrapleural pressures. IVF was then administered per the patient’s predetermined treatment, and the same six measurements were repeated after completion of fluid bolus. The difference in caval index (dCI) was calculated for all six data sets and correlated with the mL/kg of IVF administered. There was a statistically significant correlation between mL/kg of IVFs administered and dCI at all three sites (DJ: r = 0.354, p value = 0.0002; 2HVJ: r = 0.334, p value = 0.0003; LRVJ: r = 0.192, p value = 0.03). The greatest correlation between amount of fluids administered and dCI was observed along the IVC at the site 2 cm caudal to the juncture of the hepatic veins (2HVJ). This site is also where the largest change in diameter can be appreciated on ultrasound during intravascular volume resuscitation. Our data also suggests that every mL/kg of IVFs administered should change the dCI by 0.86-1.00%. This anticipated change in IVC diameter can be used to gauge a patient’s response to intravascular volume repletion.

SILVA, A. F. B. Modulação imunológica preventiva aplicada ao controle de infecções bacterianas por salmonella typhimurium pelo uso de lectinas. 2014. 187 f. Tese (Doutorado em Biotecnologia) - Centro de Ciências, Universidade Federal do Ceará, Fortaleza, 2014. / Submitted by Daniel Eduardo Alencar da Silva (dealencar.silva@gmail.com) on 2015-01-26T20:09:35Z No. of bitstreams: 1 2014_tese_afbsilva.pdf: 3169804 bytes, checksum: a77234431314940251d5a522a74d4cae (MD5) / Approved for entry into archive by José Jairo Viana de Sousa(jairo@ufc.br) on 2015-11-25T13:48:27Z (GMT) No. of bitstreams: 1 2014_tese_afbsilva.pdf: 3169804 bytes, checksum: a77234431314940251d5a522a74d4cae (MD5) / Made available in DSpace on 2015-11-25T13:48:27Z (GMT). No. of bitstreams: 1 2014_tese_afbsilva.pdf: 3169804 bytes, checksum: a77234431314940251d5a522a74d4cae (MD5) Previous issue date: 2014 / Infectious diseases are a leading cause of death throughout the world. Among these, bacterial infections stand out due to the enormous diversity of bacteria and their evolutionary and adaptive abilities. Inappropriate inflammatory responses have been associated with these infections and despite contemporaneous scientific approaches, timely diagnosis and proper treatment of systemic bacterial infection are still a challenge for public health. Thus, this study evaluated the ability of Canavalia brasiliensis (ConBr) and Cratylia argentea (CFL) lectin in modulating systemic inflammation caused by Salmonella enterica serovar Typhimurium. The lectins were purified by affinity chromatography on Sephadex G50. Toxicology and the pharmacological security of lectins was evaluated. Both lectins exhibited no toxicity up to 2000 mg/kg. Mice were inoculated intraperitoneally with lectins (10 mg/kg) within 72, 48 and 24 h before infection with Salmonella (107 CFU/mL). Animals treated with ConBr and CFL, respectively, showed 100% and 90% survival, seven days after infection. This protocol significantly reduced the bacteria in blood, peritoneal fluid and in main organs such as liver and spleen. It was also observed a reversal of the neutrophil migration failure, leukopenia, as well as reduction of cytokine levels (TNF- α, IL- 1 and IL -10) and nitric oxide on the serum. In addition, elevated peritoneal fluid concentration of nitric oxide and increase in the number of platelets were found. In vitro analyzes identified that both lectins did not exhibit antibacterial activity, can decrease the time of activation of complement system and increase intrinsic and extrinsic clotting time. Lectins had no curative effect when administered after infection and none protective effect when inoculated either intravenously or orally. Through proteomic analysis, proteins related to infection and to modulating action of lectins were identified. According to our results, we found that lectins can act on macrophages/monocytes, controlling their activation and thereby influencing the inflammatory process, protecting the animals from septic shock. These results represent an interesting approach for the control of infections, using lectins independently or associated with antibiotics whose action is directly on microorganisms. / Doenças infecciosas constituem a principal causa de morte em todo o mundo. Dentre estas, as causadas por infecções bacterianas se destacam devido à diversidade de bactérias e à sua capacidade evolutiva e adaptativa. Respostas inflamatórias inadequadas estão associadas a essas infecções e em detrimento de avanços científicos, o diagnóstico precoce e o tratamento de quadros de infecções bacterianas sistêmicas permanecem um desafio à saúde pública. Neste contexto, este estudo avaliou a capacidade da lectina de Canavalia brasiliensis (ConBr) e Cratylia argentea (CFL) em modular a inflamação sistêmica causada por Salmonella enterica sorotipo Typhimurium. As lectinas foram purificadas por cromatografia de afinidade em coluna de Sephadex G-50 e ensaios de avaliação toxicológica e segurança farmacológica foram realizados. Ambas as lectinas não demonstraram toxicidade até a máxima dose de 2000 mg/kg. Então, camundongos foram inoculados, por via intraperitoneal, com as lectinas (10 mg/kg), 72, 48 e 24 horas antes de serem infectados com a Salmonella (107 UFC/mL). Foi observada uma sobrevida de 100% e 90% dos animais tratados com a ConBr e CFL, respectivamente, avaliados no sétimo dia. Este protocolo reduziu significativamente o número de bactérias no sangue, fluído peritoneal e nos principais órgãos da infecção (baço e fígado). Foi observado ainda reversão da falência na migração de neutrófilos, leucopenia, bem como, redução nos níveis de citocinas (TNF-α, IL-1 e IL-10) e óxido nítrico no soro. Foi também verificado um aumento na concentração de óxido nítrico no fluido peritoneal e do número de plaquetas no sangue. Análises in vitro mostraram que ambas as lectinas não apresentam atividade bactericida, reduzem o tempo de ativação do sistema complemento e aumentam o tempo de coagulação intrínseca e extrínseca. As lectinas não apresentaram efeito curativo quando administradas após a infecção e não demonstraram efeito preventivo quando inoculadas por via endovenosa ou oral. Através da análise proteômica, proteínas relacionadas à infecção e à ação moduladora das lectinas foram identificadas. Assim, as lectinas possivelmente atuam sobre os macrófagos/monócitos, controlando sua ativação, e desta forma, atenuando o processo inflamatório e protegendo os animais do choque séptico. Estes resultados representam uma interessante perspectiva para o controle de infecções, com uso independente ou associado a antibióticos de ação direta sobre microrganismos

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