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Pereira EG, Carvalho MM, Oliveira T, Sacramento T, Cruz H, Viegas R, Fontes AP, Marreiros A, Sousa JP. Benefits of Tranexamic Acid in Total Knee Arthroplasty: A Classification and Regression Tree Analysis in Function of Instrumentation, BMI, and Gender. J Knee Surg 2023; 36:173-180. [PMID: 34225366 DOI: 10.1055/s-0041-1731455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Tranexamic acid (TXA) is an antifibrinolytic drug that reduces blood loss in patients that undergo Total knee arthroplasty (TKA). Few studies compare its effect on conventional instrumentation (CI) versus patient-specific instrumentation (PSI). The main objective of this study was to understand analytically how TXA usage in both instrumentations influenced blood loss in TKA differently and see if the differences seen could be explained by the patient's body mass index (BMI) and gender. This nonrandomized retrospective study sample consisted of 688 TKA procedures performed on patients who had symptomatic arthrosis resistant to conservative treatment. Descriptive analysis was used to evaluate blood loss using hemoglobin (Hb) mean values and mean variation (%). The Classification and Regression Tree (CRT) method was applied to understand how the independent variables affected the dependent variable. Comparing patients submitted to the same instrumentation, where some received TXA and others did not, patients that received TXA had lower blood loss. Comparing patients who underwent TKA with different instrumentations and without the use of TXA, it was found that patients who underwent TKA with PSI had lower blood loss than those who underwent TKA with CI. However, when these same instruments were compared again, but associated with the use of TXA, the opposite was true with patients undergoing TKA with PSI showing greater blood loss than patients undergoing TKA with CI. TXA usage in TKA is significantly beneficial in minimizing blood loss and regardless of instrumentation. When using TXA, the lowest blood loss was obtained in patients with higher BMI and submitted to TKA with CI. This is most likely explained by the synergistic antifibrotic effect of TXA with adipokines, such as plasminogen activator inhibitor-1 (PAI-1), found in the femoral bone marrow which is perforated using CI. If, however, TXA wasn't used, the lowest blood loss was obtained in patients submitted to TKA with PSI.
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Affiliation(s)
- Eduardo G Pereira
- Universidade do Algarve-Faculdade de Medicina e Ciências Biomédicas, Campus de Gambelas Faro, Portugal
| | - Maria M Carvalho
- Departamento de Ortopedia e Traumatologia, Hospital Particular do Algarve-Urbanização Casal de Gambelas, Lote 2, Gambelas Faro, Portugal
| | - Tiago Oliveira
- Departamento de Ortopedia e Traumatologia, Hospital Particular do Algarve-Urbanização Casal de Gambelas, Lote 2, Gambelas Faro, Portugal
| | - Telmo Sacramento
- Departamento de Ortopedia e Traumatologia, Hospital Particular do Algarve-Urbanização Casal de Gambelas, Lote 2, Gambelas Faro, Portugal
| | - Henrique Cruz
- Departamento de Ortopedia e Traumatologia, Hospital Particular do Algarve-Urbanização Casal de Gambelas, Lote 2, Gambelas Faro, Portugal
| | - Rui Viegas
- Departamento de Ortopedia e Traumatologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - Ana P Fontes
- Departamento de Ortopedia e Traumatologia, Hospital Particular do Algarve-Urbanização Casal de Gambelas, Lote 2, Gambelas Faro, Portugal
| | - Ana Marreiros
- Universidade do Algarve-Faculdade de Medicina e Ciências Biomédicas, Campus de Gambelas Faro, Portugal.,Algarve Biomedical Center - Research Institute (ABC-RI)-Faculdade de Medicina e Ciência Biomédicas, Campus de Gambelas Faro, Portugal
| | - João P Sousa
- Departamento de Ortopedia e Traumatologia, Hospital Particular do Algarve-Urbanização Casal de Gambelas, Lote 2, Gambelas Faro, Portugal
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Calvao J, Braga M, Brandao M, Campinas A, Alexandre A, Amador AF, Costa C, Carvalho MM, Pinto RA, Proenca T, Silva JC, Pires-Morais G, Silva MP, Brochado B, Macedo F. Acute total occlusion of the unprotected left main coronary artery – patient characteristics and outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Acute total occlusion of the unprotected left main coronary artery (ATOLMCA) is a dramatic entity with very high mortality. Owing to its infrequency, there is limited and inconsistent data regarding this population.
Purpose
To describe the clinical presentation, short- and long-term outcomes of patients with ATOLMCA.
Methods
This retrospective multicentric cohort study included all patients presenting with acute (<12h) myocardial infarction (MI) due to ATOLMCA (Thrombolysis In Myocardial Infarction - TIMI=0) between January 2008 and December 2020 in three tertiary hospitals.
Results
In the period of the study, 11,036 emergent coronary angiographies were performed in the participating centers, 59 of which were ATOLMCA (0.5%). Mean age of patients at the time of the event was 61.2 (±12.2) years. Seventy-three percent were male. At presentation, 72.9% of patients were in cardiogenic shock, and aborted cardiac arrest occurred in 27.1%. Right dominance was present in all patients except one, who had a balanced dominance. Primary percutaneous coronary intervention (PCI) was performed in 89.8% of the patients, with angiographic success being achieved in 55.6% of the procedures. Overall, the in-hospital mortality rate was 57.6%. Mortality was significantly higher in patients without angiographic criteria for PCI success (87.5 vs 36.7%, p<0.001). Among survivors, 91.7% were still alive at 1-year and 66.7% at 5 years of follow-up.
Conclusion
Patients with ATOLMCA have a dismal prognosis. Most patients present with cardiogenic shock, and a significant number develop cardiac arrest during the acute phase. Despite medical care, in-hospital mortality is high. Patients with left dominance may not even reach the hospital. Among survivors, long term outcomes are reasonable. Further studies are needed in order to improve the management and outcomes of patients with ATOLMCA.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Calvao
- Sao Joao Hospital , Porto , Portugal
| | - M Braga
- Sao Joao Hospital , Porto , Portugal
| | - M Brandao
- Hospital Center of Vila Nova de Gaia/Espinho , Vila Nova de Gaia , Portugal
| | - A Campinas
- Hospital Center of Porto , Porto , Portugal
| | | | | | - C Costa
- Sao Joao Hospital , Porto , Portugal
| | | | - R A Pinto
- Sao Joao Hospital , Porto , Portugal
| | - T Proenca
- Sao Joao Hospital , Porto , Portugal
| | - J C Silva
- Sao Joao Hospital , Porto , Portugal
| | - G Pires-Morais
- Hospital Center of Vila Nova de Gaia/Espinho , Vila Nova de Gaia , Portugal
| | - M P Silva
- Hospital Center of Vila Nova de Gaia/Espinho , Vila Nova de Gaia , Portugal
| | - B Brochado
- Hospital Center of Porto , Porto , Portugal
| | - F Macedo
- Sao Joao Hospital , Porto , Portugal
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Araújo N, Viegas CSB, Zubía E, Magalhães J, Ramos A, Carvalho MM, Cruz H, Sousa JP, Blanco FJ, Vermeer C, Simes DC. Amentadione from the Alga Cystoseira usneoides as a Novel Osteoarthritis Protective Agent in an Ex Vivo Co-Culture OA Model. Mar Drugs 2020; 18:E624. [PMID: 33297528 PMCID: PMC7762386 DOI: 10.3390/md18120624] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/27/2020] [Accepted: 11/27/2020] [Indexed: 12/21/2022] Open
Abstract
Osteoarthritis (OA) remains a prevalent chronic disease without effective prevention and treatment. Amentadione (YP), a meroditerpenoid purified from the alga Cystoseira usneoides, has demonstrated anti-inflammatory activity. Here, we investigated the YP anti-osteoarthritic potential, by using a novel OA preclinical drug development pipeline designed to evaluate the anti-inflammatory and anti-mineralizing activities of potential OA-protective compounds. The workflow was based on in vitro primary cell cultures followed by human cartilage explants assays and a new OA co-culture model, combining cartilage explants with synoviocytes under interleukin-1β (IL-1β) or hydroxyapatite (HAP) stimulation. A combination of gene expression analysis and measurement of inflammatory mediators showed that the proposed model mimicked early disease stages, while YP counteracted inflammatory responses by downregulation of COX-2 and IL-6, improved cartilage homeostasis by downregulation of MMP3 and the chondrocytes hypertrophic differentiation factors Col10 and Runx2. Importantly, YP downregulated NF-κB gene expression and decreased phosphorylated IkBα/total IkBα ratio in chondrocytes. These results indicate the co-culture as a relevant pre-clinical OA model, and strongly suggest YP as a cartilage protective factor by inhibiting inflammatory, mineralizing, catabolic and differentiation processes during OA development, through inhibition of NF-κB signaling pathways, with high therapeutic potential.
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Affiliation(s)
- Nuna Araújo
- Centre of Marine Sciences (CCMAR), University of Algarve, 8005-139 Faro, Portugal; (N.A.); (C.S.B.V.)
| | - Carla S. B. Viegas
- Centre of Marine Sciences (CCMAR), University of Algarve, 8005-139 Faro, Portugal; (N.A.); (C.S.B.V.)
- GenoGla Diagnostics, Centre of Marine Sciences (CCMAR), University of Algarve, 8005-139 Faro, Portugal
| | - Eva Zubía
- Department of Organic Chemistry, Faculty of Marine and Environmental Sciences, University of Cadiz, 11510 Puerto Real (Cádiz), Spain;
| | - Joana Magalhães
- Unidad de Medicina Regenerativa, Grupo de Investigación en Reumatología (GIR), Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), Sergas, 15006 A Coruña, Spain; (J.M.); (F.J.B.)
- Agrupación Estratégica CICA-INIBIC, Universidade da Coruña (UDC), 15006 A Coruña, Spain
- Centro de Investigación Biomédica en Red (CIBER), 28029 Madrid, Spain
| | - Acácio Ramos
- Department of Orthopedics and Traumatology, Hospital Particular do Algarve (HPA), 8005-226 Gambelas-Faro, Portugal; (A.R.); (M.M.C.); (H.C.); (J.P.S.)
| | - Maria M. Carvalho
- Department of Orthopedics and Traumatology, Hospital Particular do Algarve (HPA), 8005-226 Gambelas-Faro, Portugal; (A.R.); (M.M.C.); (H.C.); (J.P.S.)
| | - Henrique Cruz
- Department of Orthopedics and Traumatology, Hospital Particular do Algarve (HPA), 8005-226 Gambelas-Faro, Portugal; (A.R.); (M.M.C.); (H.C.); (J.P.S.)
| | - João Paulo Sousa
- Department of Orthopedics and Traumatology, Hospital Particular do Algarve (HPA), 8005-226 Gambelas-Faro, Portugal; (A.R.); (M.M.C.); (H.C.); (J.P.S.)
| | - Francisco J. Blanco
- Unidad de Medicina Regenerativa, Grupo de Investigación en Reumatología (GIR), Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), Sergas, 15006 A Coruña, Spain; (J.M.); (F.J.B.)
- Agrupación Estratégica CICA-INIBIC, Universidade da Coruña (UDC), 15006 A Coruña, Spain
| | - Cees Vermeer
- Cardiovascular Research Institute CARIM, Maastricht University, 6229 EV Maastricht, The Netherlands;
| | - Dina C. Simes
- Centre of Marine Sciences (CCMAR), University of Algarve, 8005-139 Faro, Portugal; (N.A.); (C.S.B.V.)
- GenoGla Diagnostics, Centre of Marine Sciences (CCMAR), University of Algarve, 8005-139 Faro, Portugal
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Viegas R, Kumar A, Carvalho MM, Vide J, Fontes AP, Sousa JP. Impact of age, gender and body mass index on the efficacy of tranexamic acid in total knee arthroplasty. ACTA ACUST UNITED AC 2020. [DOI: 10.18203/issn.2455-4510.intjresorthop20203710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<p class="abstract"><strong>Background:</strong> Tranexamic acid (TXA) is effective and safe in decreasing blood loss and transfusion rate in total knee arthroplasty (TKA). Few studies focused on the role of patients’ characteristics on the efficacy of TXA in TKA. The purpose of this study was to conduct a retrospective analysis to investigate if age, gender and BMI influence the efficacy of TXA in reducing perioperative blood loss in TKA.</p><p class="abstract"><strong>Methods:</strong> We did an observational study including 366 consecutive patients undergoing TKA in Hospital Particular do Algarve between January 2011 and April 2019 which were divided in two groups: intraoperative administration of intravenous TXA (TXA Group) and no administration of TXA (Control Group). The perioperative blood loss between groups and their relation with age, gender and BMI was compared.<strong></strong></p><p class="abstract"><strong>Results:</strong> Of the 366 patients, 225 (61%) received TXA. In both groups, age did not correlate to the blood loss. Women in the TXA group had less perioperative blood loss than in the control group. No such difference was found for men. The normal weight group showed no difference in perioperative blood loss with or without TXA administration. However, there was a statistically significant difference in the overweight and obese groups. The mean perioperative blood loss was higher in the control group (854±342 ml) than in the TXA group (720±335 ml).</p><p class="abstract"><strong>Conclusions:</strong> TXA administration is efficient in controlling TKA associated hemorrhage in overweight and obese individuals and in women but it doesn’t have that effect in normal weight patients or in men.</p>
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Nunes JC, Carvalho MM, Sugui JK, Queiroz FA, Santana AE, Hata ME, Aiura ALO, Oliveira JA, Queiroz SA. EFFECT OF LITTER SUBSTRATES ON THE PERFORMANCE, CARCASS TRAITS, AND ENVIRONMENTAL COMFORT OF RED-WINGED TINAMOU (RHYNCHOTUS RUFESCENS). Rev Bras Cienc Avic 2016. [DOI: 10.1590/1806-9061-2015-0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- JC Nunes
- Wageningen University, The Netherlands
| | - MM Carvalho
- Environment Department of the city of Diadema, Brazil
| | | | | | | | | | - ALO Aiura
- State University of Montes Claros, Brazil
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Oliveira MR, Carvalho MM, Silva NB, Yamamoto ME, Chellappa S. Reproductive aspects of the flyingfish, Hirundichthys affinis from the Northeastern coastal waters of Brazil. BRAZ J BIOL 2015; 75:198-207. [PMID: 25945638 DOI: 10.1590/1519-6984.11513] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 08/20/2013] [Indexed: 11/22/2022] Open
Abstract
The epipelagic flyingfish, Hirundichthys affinis is a major artisanal fishery resource from the Northeastern coastal waters of Brazil. However, biological information about this species has been poorly documented. This paper presents data on the length-weight relationship, sex ratio, length at first sexual maturity, gonadal development and fecundity of H. affinis sampled from the coastal waters of Rio Grande do Norte, Brazil. The total body length and weight for both sexes ranged from 23.4 to 29.4 cm and from 89 to 188g, respectively. The allometric coefficient of males was 2.208 and that of females was 2.985, indicating negatively allometric growth. The sex ratio was 1M:1.6F thus differing from the expected ratio of 1:1 (χ2 = 18.63). The total length at first sexual maturity was estimated at 27.3 cm for males and 27.1 cm for females. The macroscopic characteristics of the gonads indicated four maturation stages. Histological studies of gonads of H. affinis showed seven phases of oocyte development and four phases of spermatocyte development. The mean absolute fecundity was 9092 vitelogenic oocytes. Spawning occurred during the months of March to July. The microscopic descriptions of the stages of gonad maturation indicate that the study area is an important spawning ground of H. affinis.
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Affiliation(s)
- M R Oliveira
- Postgraduate Program in Psychobiology, Center of Bioscience, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - M M Carvalho
- Department of Oceanography and Limnology, Center of Bioscience, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - N B Silva
- Department of Morphology, Center of Bioscience, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - M E Yamamoto
- Postgraduate Program in Psychobiology, Center of Bioscience, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - S Chellappa
- Department of Oceanography and Limnology, Center of Bioscience, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
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Sevivas N, Serra SC, Portugal R, Teixeira FG, Carvalho MM, Silva N, Espregueira-Mendes J, Sousa N, Salgado AJ. Animal model for chronic massive rotator cuff tear: behavioural and histologic analysis. Knee Surg Sports Traumatol Arthrosc 2015; 23:608-18. [PMID: 25416674 DOI: 10.1007/s00167-014-3441-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 11/13/2014] [Indexed: 01/22/2023]
Abstract
PURPOSE Massive rotator cuff tears (MRCT) are usually chronic lesions that present associated degenerative changes of the myotendinous unit that have been implicated in limitations for surgical repair. In order to develop effective therapies, it is important to establish animal models that mimic the hallmarks of the injury itself. Therefore, in the present work, we aimed to (1) optimize a rodent animal model of MRCT that closely reproduces the fatty infiltration of the cuff muscles seen in humans and (2) describe the effects of unilateral or bilateral lesion in terms of histology and behaviour. METHODS Massive tear was defined as two rotator cuff tendons-supraspinatus and infraspinatus-section. Twenty-one Wistar rats were randomly assigned to four groups: bilateral lesion (five animals), right-sided unilateral lesion (five animals), left-sided unilateral lesion (five animals) and control (six animals). Behaviour was analyzed with open field and staircase test, 16 weeks after lesion. After that, animals were killed, and the supraspinatus and infraspinatus muscles were processed. RESULTS Histologic analysis revealed adipocytes, fatty infiltration and atrophy in the injured side with a greater consistency of these degenerative changes in the bilateral lesion group. Behaviour analysis revealed a significant functional impairment of the fine motor control of the forepaw analyzed in staircase test where the number of eaten pellets was significantly higher in sham animals (sham = 7 ± 5.0; left unilateral = 2.6 ± 3.0; right unilateral = 0 ± 0; and bilateral = 0 ± 0, p < 0.05). A trend to reach a lower level of steps, in more injured animals, was also observed (sham animals = 3 ± 1.6 > left unilateral = 2 ± 2.1 > right unilateral = 0.8 ± 1.3 > bilateral = 0.8 ± 1.1). CONCLUSIONS The present study has been able to establish an animal model that disclosed the hallmarks of MRCT. This can now be used as a valuable, cost-effective, pre-clinical instrument to assist in the development of advanced tissue engineered strategies. Moreover, this animal model overcomes some of the limitations of those that have been reported so far and thus represents a more reliable source for the assessment of future therapeutic strategies with potential clinical relevance.
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Affiliation(s)
- N Sevivas
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal,
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Martins WR, Carvalho MM, Mota MR, Cipriano GFB, Mendes FAS, Diniz LR, Junior GC, Carregaro RL, Durigan JLQ. Diacutaneous fibrolysis versus passive stretching after articular immobilization: Muscle recovery and extracellular matrix remodelling. ACTA ACUST UNITED AC 2013. [DOI: 10.13172/2053-0781-1-2-1023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Rodrigues AJ, Leão P, Pêgo JM, Cardona D, Carvalho MM, Oliveira M, Costa BM, Carvalho AF, Morgado P, Araújo D, Palha JA, Almeida OFX, Sousa N. Mechanisms of initiation and reversal of drug-seeking behavior induced by prenatal exposure to glucocorticoids. Mol Psychiatry 2012; 17:1295-305. [PMID: 21968930 DOI: 10.1038/mp.2011.126] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Stress and exposure to glucocorticoids (GC) during early life render individuals vulnerable to brain disorders by inducing structural and chemical alterations in specific neural substrates. Here we show that adult rats that had been exposed to in utero GCs (iuGC) display increased preference for opiates and ethanol, and are more responsive to the psychostimulatory actions of morphine. These animals presented prominent changes in the nucleus accumbens (NAcc), a key component of the mesolimbic reward circuitry; specifically, cell numbers and dopamine (DA) levels were significantly reduced, whereas DA receptor 2 (Drd2) mRNA expression levels were markedly upregulated in the NAcc. Interestingly, repeated morphine exposure significantly downregulated Drd2 expression in iuGC-exposed animals, in parallel with increased DNA methylation of the Drd2 gene. Administration of a therapeutic dose of L-dopa reverted the hypodopaminergic state in the NAcc of iuGC animals, normalized Drd2 expression and prevented morphine-induced hypermethylation of the Drd2 promoter. In addition, L-dopa treatment promoted dendritic and synaptic plasticity in the NAcc and, importantly, reversed drug-seeking behavior. These results reveal a new mechanism through which drug-seeking behaviors may emerge and suggest that a brief and simple pharmacological intervention can restrain these behaviors in vulnerable individuals.
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Affiliation(s)
- A J Rodrigues
- Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal
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Peixoto MR, Monego ET, Jardim PC, Carvalho MM, Sousa AL, Oliveira JS, Balestra Neto O. Diet and medication in the treatment of hyperuricemia in hypertensive patients. Arq Bras Cardiol 2001; 76:463-72. [PMID: 11449292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
OBJECTIVE To evaluate the effects of diet and medication, either isolated or associated, on serum levels of uric acid in patients with hyperuricemia. METHODS We studied patients from the Hypertension Unit of the University of Goias who had hyperuricemia (men > or =8.5 mg/dL and women > or =7.5 mg/dL). We divided the patients into three groups: G1 (low purine diet), G2 (low purine diet + medication), and G3 (medication only). Patients received allopurinol, 150 mg/day titrated up to 300 mg/dL when necessary. Patients were evaluated with regards to their lifestyles (diet, smoking, physical, activity, alcohol consumption), uric acid, blood pressure, use of medication, body mass index, cholesterol, and triglyceride. Follow-up took place in weeks 0 (M1), 6 (M2), 12 (M3) during the intervention and in week 36 (M4) after the study was completed. RESULTS Fifty-five patients participated in the study, 31 women, mean age 54.4+/-10.6 years, body mass index 28.6+/-3.9 kg/m2. A similar reduction (p<0.001) in uric acid levels occurred in the three intervention groups. In week 36 (M4), after 24 weeks without intervention, a tendency toward elevation of uricemia was noted in G2 and G3, and a continuous drop in uricemia was noted in G1. No significant modifications were observed in the other variables analyzed. CONCLUSION Considering the cost x benefit relationship, a diet low in purine should be the 1st therapeutic option for controlling hyperuricemia in patients with similar characteristic to the ones presented in this study.
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Affiliation(s)
- M R Peixoto
- Faculdades de Medicina Enfermagem e Nutrição, Universidade Federal de Goiás, Goiânia, GO, Brazil
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Queiroz-Telles F, Silva N, Carvalho MM, Alcântara AP, da Matta D, Barberino MG, Bartczak S, Colombo AL. Evaluation of efficacy and safety of itraconazole oral solution for the treatment of oropharyngeal candidiasis in aids patients. Braz J Infect Dis 2001; 5:60-6. [PMID: 11493410 DOI: 10.1590/s1413-86702001000200003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This study was a non-comparative multicenter clinical trial to evaluate the efficacy and tolerability of itraconazole oral solution 200 mg/day (100 mg twice a day in the fasting state) for the treatment of oropharyngeal candidiasis in AIDS patients. We included 50 patients who were treated and followed for up to 3 weeks after ending therapy in the analysis. Mycological cures at the end of therapy occurred in 20/50 patients (40%), but colonization by Candida sp. was recorded in 42/50 (84%) by the end of follow-up. A high rate of clinical response was observed in 46/50 (92%), and the response was sustained for up to 21 days after stopping therapy in 24/46 patients (52%). Clinical relapses were documented among 22 patients, but all causative fungal organisms associated with a relapse were susceptible to itraconazole. There were many patients with persistence or recurrence of Candida, but without mucositis. Relapse of Candida mucositis was significantly related to low levels of CD(4) lymphocytes exhibited by symptomatic patients. The drug was well tolerated by all but 1 patient. We conclude that itraconazole oral solution (100 mg bid for 7-14 days) is a well tolerated and effective treatment for suppressing the symptoms of oropharyngeal candidiasis in AIDS patients. Patients with severe immunosuppression may relapse and require frequent cycles of treatment or longterm suppressive therapy.
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Affiliation(s)
- F Queiroz-Telles
- Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
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Negreiros AN, Carvalho MM, Xavier Filho J, Blanco-Labra A, Shewry PR, Richardson M. The complete amino acid sequence of the major Kunitz trypsin inhibitor from the seeds of Prosopsis juliflora. Phytochemistry 1991; 30:2829-33. [PMID: 1367792 DOI: 10.1016/s0031-9422(00)98207-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The major inhibitor of trypsin in seeds of Prosopsis juliflora was purified by precipitation with ammonium sulphate, ion-exchange column chromatography on DEAE- and CM-Sepharose and preparative reverse phase HPLC on a Vydac C-18 column. The protein inhibited trypsin in the stoichiometric ratio of 1:1, but had only weak activity against chymotrypsin and did not inhibit human salivary or porcine pancreatic alpha-amylases. SDS-PAGE indicated that the inhibitor has a Mr of ca 20,000, and IEF-PAGE showed that the pI is 8.8. The complete amino acid sequence was determined by automatic degradation, and by DABITC/PITC microsequence analysis of peptides obtained from enzyme digestions of the reduced and S-carboxymethylated protein with trypsin, chymotrypsin, elastase, the Glu-specific protease from S. aureus and the Lys-specific protease from Lysobacter enzymogenes. The inhibitor consisted of two polypeptide chains, of 137 residues (alpha chain) and 38 residues (beta chain) linked together by a single disulphide bond. The amino acid sequence of the protein exhibited homology with a number of Kunitz proteinase inhibitors from other legume seeds, the bifunctional subtilisin/alpha-amylase inhibitors from cereals and the taste-modifying protein miraculin.
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Affiliation(s)
- A N Negreiros
- Departamento de Bioquimica, Universidade Federal do Rio Grande do Norte, Natal, Brazil
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