Impact of Aspergillus spp. isolation in the first 24 hours of admission in critically ill patients with severe influenza virus pneumonia

OBJECTIVE

To determine the incidence and impact of Aspergillus spp. isolation (AI) on ICU mortality in critically ill patients with severe influenza pneumonia during the first 24h of admission.

DESIGN

Secondary analysis of an observational and prospective cohort study.

SETTING

ICUs voluntary participating in the Spanish severe Influenza pneumonia registry, between June 2009 and June 2019.

PATIENTS

Consecutive patients admitted to the ICU with diagnosis of severe influenza pneumonia, confirmed by real-time polymerase chain reaction.

INTERVENTIONS

None.

MAIN VARIABLES OF INTEREST

Incidence of AI in respiratory samples. Demographic variables, comorbidities, need for mechanical ventilation and the presence of shock according at admission. Acute Physiology and Chronic Health Evaluation II (APACHE II) scale calculated on ICU admission.

RESULTS

3702 patients were analyzed in this study. AI incidence was 1.13% (n=42). Hematological malignancies (OR 4.39, 95% CI 1.92-10.04); HIV (OR 3.83, 95% CI 1.08-13.63), and other immunosuppression situations (OR 4.87, 95% CI 1.99-11.87) were factors independently associated with the presence of Aspergillus spp. The automatic CHAID decision tree showed that hematologic disease with an incidence of 3.3% was the most closely AI related variable. Hematological disease (OR 2.62 95% CI 1.95-3.51), immunosuppression (OR 2.05 95% CI 1.46-2.88) and AI (OR 3.24, 95% CI 1.60-6.53) were variables independently associated with ICU mortality.

CONCLUSIONS

Empirical antifungal treatment in our population may only be justified in immunocompromised patients. In moderate-high risk cases, active search for Aspergillus spp. should be implemented.

[Management of infectious complications associated with coronavirus infection in severe patients admitted to ICU]

Infections have become one of the main complications of patients with severe SARS-CoV-2 pneumonia admitted in ICU. Poor immune status, frequent development of organic failure requiring invasive supportive treatments, and prolonged ICU length of stay in saturated structural areas of patients are risk factors for infection development. The Working Group on Infectious Diseases and Sepsis GTEIS of the Spanish Society of Intensive Medicine and Coronary Units SEMICYUC emphasizes the importance of infection prevention measures related to health care, the detection and early treatment of major infections in the patient with SARS-CoV-2 infections. Bacterial co-infection, respiratory infections related to mechanical ventilation, catheter-related bacteremia, device-associated urinary tract infection and opportunistic infections are review in the document.

Management of infectious complications associated with coronavirus infection in severe patients admitted to ICU

Infections have become one of the main complications of patients with severe SARS-CoV-2 pneumonia admitted in ICU. Poor immune status, frequent development of organic failure requiring invasive supportive treatments, and prolonged ICU length of stay in saturated structural areas of patients are risk factors for infection development. The Working Group on Infectious Diseases and Sepsis GTEIS of the Spanish Society of Intensive Medicine and Coronary Units SEMICYUC emphasizes the importance of infection prevention measures related to health care, the detection and early treatment of major infections in the patient with SARS-CoV-2 infections. Bacterial co-infection, respiratory infections related to mechanical ventilation, catheter-related bacteremia, device-associated urinary tract infection and opportunistic infections are review in the document.

Improved survival among ICU-hospitalized patients with community-acquired pneumonia by unidentified organisms: a multicenter case-control study

A retrospective analysis from prospectively collected data was conducted in intensive care units (ICUs) at 33 hospitals in Europe comparing the trend in ICU survival among adults with severe community-acquired pneumonia (CAP) due to unknown organisms from 2000 to 2015. The secondary objective was to establish whether changes in antibiotic policies were associated with different outcomes. ICU mortality decreased (p = 0.02) from 26.9 % in the first study period (2000-2002) to 15.7 % in the second period (2008-2015). Demographic data and clinical severity at admission were comparable between groups, except for age over 65 years and incidence of cardiomyopathy. Over time, patients received higher rates of combination therapy (94.3 vs. 77.2 %; p < 0.01) and early (<3 h) antibiotic delivery (72.9 vs. 50.3 %; p < 0.01); likewise, the 2008-2015 group was more likely to receive adequate antibiotic prescription [as defined by the Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) guidelines] than the 2000-2002 group (70.7 vs. 48.2 %; p < 0.01). Multivariate analysis showed an independent association between decreased ICU mortality and early (<3 h) antibiotic administration [odds ratio (OR) 3.48 [1.70-7.15], p < 0.01] or adequate antibiotic prescription according to guidelines (OR 2.22 [1.11-4.43], p = 0.02). In conclusion, our findings suggest that ICU mortality in severe CAP due to unidentified organisms has decreased in the last 15 years. Several changes in management and better compliance with guidelines over time were associated with increased survival.

Impact of a multifaceted educational intervention including serious games to improve the management of invasive candidiasis in critically ill patients

OBJECTIVES

Infections caused by Candida species are common in critically ill patients and contribute to significant morbidity and mortality. The EPICO Project (Epico 1 and Epico 2.0 studies) recently used a Delphi approach to elaborate guidelines for the diagnosis and treatment of this condition in critically ill adult patients. We aimed to evaluate the impact of a multifaceted educational intervention based on the Epico 1 and Epico 2.0 recommendations.

DESIGN

Specialists anonymously responded to two online surveys before and after a multifaceted educational intervention consisting of 60-min educational sessions, the distribution of slide kits and pocket guides with the recommendations, and an interactive virtual case presented at a teleconference and available for online consultation.

SETTING

A total of 74 Spanish hospitals.

PARTICIPANTS

Specialists of the Intensive Care Units in the participating hospitals.

VARIABLES OF INTEREST

Specialist knowledge and reported practices evaluated using a survey. The McNemar test was used to compare the responses in the pre- and post-intervention surveys.

RESULTS

A total of 255 and 248 specialists completed both surveys, in both periods, respectively. The pre-intervention surveys showed many specialists to be unaware of the best approach for managing invasive candidiasis. After both educational interventions, specialist knowledge and reported practices were found to be more in line with nearly all the recommendations of the Epico 1 and Epico 2.0 guidelines, except as regards de-escalation from echinocandins to fluconazole in Candida glabrata infections (p=0.055), and the duration of antifungal treatment in both candidemia and peritoneal candidiasis.

CONCLUSIONS

This multifaceted educational intervention based on the Epico Project recommendations improved specialist knowledge of the management of invasive candidiasis in critically ill patients.

EPICO 2.0 PROJECT. Development of educational therapeutic recommendations using the DELPHI technique on invasive candidiasis in critically ill adult patients in special situations

INTRODUCTION

Although there has been an improved management of Invasive Candidiasis in the last decade, still controversial issues remain, especially in different therapeutic critical care scenarios.

OBJECTIVES

We sought to identify the core clinical knowledge and to achieve high agreement recommendations required to care for critically ill adult patients with Invasive Candidiasis for antifungal treatment in special situations and different scenarios.

METHODS

Second Prospective Spanish survey reaching consensus by the Delphi technique, conducted anonymously by electronic e-mail in the first phase to 23 national multidisciplinary experts in invasive fungal infections from five national scientific societies including Intensivists, Anesthesiologists, Microbiologists, Pharmacologists and Infectious disease specialists, answering 30 questions prepared by a coordination group after a strict review of literature in the last five years. The educational objectives spanned four categories, including peritoneal candidiasis, immunocompromised patients, special situations and organ failures. The agreement among panelists in each item should be higher than 75% to be selected. In a second phase, after extracting recommendations from the selected items, a meeting was held with more than 60 specialists in a second round invited to validate the preselected recommendations.

MEASUREMENTS AND MAIN RESULTS

In the first phase, 15 recommendations were preselected (peritoneal candidiasis (3), immunocompromised patients (6), special situations (3) and organ failures (3)). After the second round the following 13 were validated: Peritoneal candidiasis (3): Source control and early adequate antifungal treatment is mandatory; empirical antifungal treatment is recommended in secondary nosocomial peritonitis with Candida spp. colonization risk factors and in tertiary peritonitis. Immunocompromised patients (5): Consider hepatotoxicity and interactions before starting antifungal treatment with azoles in transplanted patients; treat candidemia in neutropenic adult patients with antifungal drugs at least 14 days after the first negative blood culture and until normalization of neutrophil count is achieved. Caspofungin, if needed, is the echinocandin with most scientific evidence to treat candidemia in neutropenic adult patients; Caspofungin is also the first choice drug to treat febrile candidemia; in neutropenic patients with candidemia remove catheter. Special situations (2): In moderate hepatocellular failure, patients with invasive candidiasis use echinocandins (preferably low doses of anidulafungin and caspofungin) and try to avoid azoles; in case of possible interactions review all of the drugs involved and preferably use Anidulafungin. Organ failures (3): Echinocandins are the safest antifungal drugs; reconsider the use of azoles in patients under renal replacement therapy; all of the echinocandins are accepted for the treatment of patients under continuous renal replacement therapy and do not require dosage adjustment.

CONCLUSIONS

Treatment of Invasive Candidiasis in ICU patients requires a broad range of knowledge and skills as summarized in our recommendations. These recommendations may help to optimize the therapeutic management of these patients in special situations and different scenarios and improve their outcome based on the DELPHI methodology.

Epidemiology and predictive factors for early and late mortality in Candida bloodstream infections: a population-based surveillance in Spain

A prospective, multicentre, population-based surveillance programme for Candida bloodstream infections was implemented in five metropolitan areas of Spain to determine its incidence and the prevalence of antifungal resistance, and to identify predictors of death. Between May 2010 and April 2011, Candida isolates were centralized to a reference laboratory for species identification by DNA sequencing and for susceptibility testing by EUCAST reference procedure. Prognostic factors associated with early (0-7 days) and late (8-30 days) death were analysed using logistic regression modelling. We detected 773 episodes: annual incidence of 8.1 cases/100 000 inhabitants, 0.89/1000 admissions and 1.36/10 000 patient-days. Highest incidence was found in infants younger than 1 year (96.4/100 000 inhabitants). Candida albicans was the predominant species (45.4%), followed by Candida parapsilosis (24.9%), Candida glabrata (13.4%) and Candida tropicalis (7.7%). Overall, 79% of Candida isolates were susceptible to fluconazole. Cumulative mortality at 7 and 30 days after the first episode of candidaemia was 12.8% and 30.6%, respectively. Multivariate analysis showed that therapeutic measures within the first 48 h may improve early mortality: antifungal treatment (OR 0.51, 95% CI 0.27-0.95) and central venous catheter removal (OR 0.43, 95% CI 0.21-0.87). Predictors of late death included host factors (e.g. patients' comorbid status and signs of organ dysfunction), primary source (OR 1.63, 95% CI 1.03-2.61), and severe sepsis or septic shock (OR 1.77, 95% CI 1.05-3.00). In Spain, the proportion of Candida isolates non-susceptible to fluconazole is higher than in previous reports. Early mortality may be improved with strict adherence to guidelines.

Community-acquired Legionella Pneumonia in the intensive care unit: Impact on survival of combined antibiotic therapy

OBJECTIVES

To compare intensive care unit (ICU) mortality in patients with severe community-acquired pneumonia (SCAP) caused by Legionella pneumophila receiving combined therapy or monotherapy.

METHODS

A prospective multicenter study was made, including all patients with sporadic, community-acquired Legionnaires' disease (LD) admitted to the ICU. Admission data and information on the course of the disease were recorded. Antibiotic prescriptions were left to the discretion of the attending physician and were not standardized.

RESULTS

Twenty-five cases of SCAP due to L. pneumophila were included, and 7 patients (28%) out of 25 died after a median of 7 days of mechanical ventilation. Fifteen patients (60%) presented shock. Levofloxacin and clarithromycin were the antibiotics most commonly used in monotherapy, while the most frequent combination was rifampicin plus clarithromycin. Patients subjected to combination therapy presented a lower mortality rate versus patients subjected to monotherapy (odds ratio for death [OR] 0.15; 95%CI 0.02-1.04; p=0.08). In patients with shock, this association was stronger and proved statistically significant (OR for death 0.06; 95%CI 0.004-0.86; p=0.04).

CONCLUSIONS

Combined antibiotic therapy decreases mortality in patients with SCAP and shock caused by L. pneumophila.

[Recommendations of the Infectious Diseases Work Group (GTEI) of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) and the Infections in Critically Ill Patients Study Group (GEIPC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) for the diagnosis and treatment of influenza A/H1N1 in seriously ill adults admitted to the Intensive Care Unit]

The diagnosis of influenza A/H1N1 is mainly clinical, particularly during peak or seasonal flu outbreaks. A diagnostic test should be performed in all patients with fever and flu symptoms that require hospitalization. The respiratory sample (nasal or pharyngeal exudate or deeper sample in intubated patients) should be obtained as soon as possible, with the immediate start of empirical antiviral treatment. Molecular methods based on nucleic acid amplification techniques (RT-PCR) are the gold standard for the diagnosis of influenza A/H1N1. Immunochromatographic methods have low sensitivity; a negative result therefore does not rule out active infection. Classical culture is slow and has low sensitivity. Direct immunofluorescence offers a sensitivity of 90%, but requires a sample of high quality. Indirect methods for detecting antibodies are only of epidemiological interest. Patients with A/H1N1 flu may have relative leukopenia and elevated serum levels of LDH, CPK and CRP, but none of these variables are independently associated to the prognosis. However, plasma LDH> 1500 IU/L, and the presence of thrombocytopenia <150 x 10(9)/L, could define a patient population at risk of suffering serious complications. Antiviral administration (oseltamivir) should start early (<48 h from the onset of symptoms), with a dose of 75 mg every 12h, and with a duration of at least 7 days or until clinical improvement is observed. Early antiviral administration is associated to improved survival in critically ill patients. New antiviral drugs, especially those formulated for intravenous administration, may be the best choice in future epidemics. Patients with a high suspicion of influenza A/H1N1 infection must continue with antiviral treatment, regardless of the negative results of initial tests, unless an alternative diagnosis can be established or clinical criteria suggest a low probability of influenza. In patients with influenza A/H1N1 pneumonia, empirical antibiotic therapy should be provided due to the possibility of bacterial coinfection. A beta-lactam plus a macrolide should be administered as soon as possible. The microbiological findings and clinical or laboratory test variables may decide withdrawal or not of antibiotic treatment. Pneumococcal vaccination is recommended as a preventive measure in the population at risk of suffering severe complications. Although the use of moderate- or low-dose corticosteroids has been proposed for the treatment of influenza A/H1N1 pneumonia, the existing scientific evidence is not sufficient to recommend the use of corticosteroids in these patients. The treatment of acute respiratory distress syndrome in patients with influenza A/H1N1 must be based on the use of a protective ventilatory strategy (tidal volume <10 ml / kg and plateau pressure <35 mmHg) and positive end-expiratory pressure set to high patient lung mechanics, combined with the use of prone ventilation, muscle relaxation and recruitment maneuvers. Noninvasive mechanical ventilation cannot be considered a technique of choice in patients with acute respiratory distress syndrome, though it may be useful in experienced centers and in cases of respiratory failure associated with chronic obstructive pulmonary disease exacerbation or heart failure. Extracorporeal membrane oxygenation is a rescue technique in refractory acute respiratory distress syndrome due to influenza A/H1N1 infection. The scientific evidence is weak, however, and extracorporeal membrane oxygenation is not the technique of choice. Extracorporeal membrane oxygenation will be advisable if all other options have failed to improve oxygenation. The centralization of extracorporeal membrane oxygenation in referral hospitals is recommended. Clinical findings show 50-60% survival rates in patients treated with this technique. Cardiovascular complications of influenza A/H1N1 are common. Such problems may appear due to the deterioration of pre-existing cardiomyopathy, myocarditis, ischemic heart disease and right ventricular dysfunction. Early diagnosis and adequate monitoring allow the start of effective treatment, and in severe cases help decide the use of circulatory support systems. Influenza vaccination is recommended for all patients at risk. This indication in turn could be extended to all subjects over 6 months of age, unless contraindicated. Children should receive two doses (one per month). Immunocompromised patients and the population at risk should receive one dose and another dose annually. The frequency of adverse effects of the vaccine against A/H1N1 flu is similar to that of seasonal flu. Chemoprophylaxis must always be considered a supplement to vaccination, and is indicated in people at high risk of complications, as well in healthcare personnel who have been exposed.

Constitutive activation of JAK2 in mammary epithelium elevates Stat5 signalling, promotes alveologenesis and resistance to cell death, and contributes to tumourigenesis

Signalling through the janus kinase (JAK)/signal transducer and activator of transcription (Stat) pathway is required at different stages of mammary gland development, and this pathway is frequently hyper-activated in cancer, including tumours of the breast. Stats 3, 5 and 6 have important roles in the differentiation and survival of mammary alveolar cells, but somewhat paradoxically, both Stat3 and 5 can have oncogenic activity in the mammary gland. Constitutive activation of JAK2 could be anticipated to result in hyper-activation of Stats 1, 3, 5 and 6 with concomitant cell transformation, although the outcome is difficult to envisage, particularly since Stats 3 and 5 play opposing roles in normal mammary gland development. Here, we show that expression of a constitutively active JAK2 mutant, JAK2 V617F, leads to hyper-activation of Stat5 in mammary epithelial cells (MECs), and transgenic mice expressing JAK2 V617F specifically in the mammary gland exhibit accelerated alveologenesis during pregnancy and delayed post-lactational regression. Overexpressing JAK2 V617F in MECs in vitro results in elevated proliferation and resistance to cell death. Furthermore, constitutively active JAK2 enhances anchorage-independent cell growth in the presence of a co-operating oncogene and accelerates tumourigenesis in a xenograft model. Taken together, our results provide insights into signalling downstream of constitutively active JAK2 and could be important for understanding the molecular mechanisms of breast tumourigenesis.

[Acute viral infections in immunocompetent patients]

Los virus tienen un papel importante dentro de las infecciones graves en los pacientes adultos, que en algunas ocasiones llegan a necesitar hospitalización e ingreso en unidades de cuidados intensivos, especialmente en casos de síndrome de distrés respiratorio del adulto y encefalitis. Las infecciones por virus influenza y parainfluenza, virus sincitial respiratorio, herpes virus y adenovirus son las que más frecuentemente causan estos cuadros. Se ha realizado una revisión de la literatura pormenorizada y actualizada de epidemiología, patogénesis, manifestaciones clínicas y aproximación terapéutica de las infecciones virales en pacientes inmunocompetentes. Por otro lado, si bien la neumonía asociada a ventilación mecánica tiene como etiología más frecuente las infecciones bacterianas, recientemente el papel de los virus como patógenos en estas infecciones está en debate, por lo que se hace una breve revisión de su papel etiopatogénico en la neumonía asociada a ventilación mecánica.

[Role of viral infections in immunosuppressed patients]

Ser receptor de un trasplante de órgano sólido, así como recibir tratamiento quimioterápico para una enfermedad hematólógica maligna, predispone claramente a padecer infecciones virales tanto comunes como oportunistas, de origen tanto comunitario como procedentes del donante de órganos y/o de una reactivación de un virus latente endógeno. Herpes virus y más especialmente citomegalovirus y virus de Epstein-Barr son los que con más frecuencia afectan a estos enfermos, así como los virus respiratorios. El tratamiento consiste en la combinación de reducir la inmunodepresión inducida junto con tratamiento antiviral. Se ha realizado una revisión de la literatura pormenorizada y actualizada de la epidemiología, la patogenia, las manifestaciones clínicas y la aproximación terapéutica de las infecciones virales en estos enfermos.

Acute viral infections in immunocompetent patients

Viruses play a significant role in serious infections in adults and sometimes lead to the need for hospitalization and admission to intensive care units, especially in cases of severe respiratory distress or encephalopathy. Influenza and parainfluenza viruses, syncytial respiratory virus, herpes viruses and adenovirures are the most frequent causes of these severe infections. A review of the literature has been performed in order to update the epidemiology, pathogenesis and therapeutic approach of viral infections affecting immunocompetent patients. Furthermore, ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection in intensive care units and has a high morbidity and mortality rate. It is mainly a bacterial disease, although the potential role of viruses as pathogens or copathogens in VAP is under discussion. Therefore, a brief review of the potential pathogenic role of viruses in VAP has also been performed.

[Endotoxin adsortion as adjuvant therapy in gram negative severe sepsis]

The mortality rate of severe sepsis and septic shock remains still high. Within the last years a better knowledge of its physiopathology and the implementation of a group of measures addressed to a fast identification and early treatment of the septic patients have proved to reduce mortality rate. Likewise, it continues being investigated in modulating the inflammatory response and limiting the harmful action of the bacterial products on the immune system. As a result of this research some endotoxin adsorber devices have been designed to control one of the most important targets that start the inflammatory cascade when gram negative microorganisms are involved.The usefulness that these endotoxin removal devices might have as adjuvant treatment in the Septic Syndrome and its applicability are reviewed in this paper. Likewise a profile of patient that might be to the benefit of this therapy is suggested according to the current knowledge.

Clinical significance of the detection of Candida albicans germ tube-specific antibodies in critically ill patients

The present study, comprising a prospective multicentre study including 53 non-neutropenic patients from intensive care units (ICU) in six Spanish tertiary-care hospitals, was carried out to determine the clinical significance and influence on mortality of Candida albicans germ tube-specific antibodies (CAGTA). There were 22 patients (41.5%) for whom the CAGTA results were positive, although none of had a blood culture positive for Candida. The intra-ICU mortality rate was significantly lower (p = 0.004) in CAGTA-positive patients (61.2% vs. 22.7%). Multivariate analysis confirmed that a positive CAGTA result was the only protective factor to be independently associated with ICU mortality (beta coefficient = -0.3856; 95% confidence interval = -0.648 to -0.123).

The influence of inadequate empirical antimicrobial treatment on patients with bloodstream infections in an intensive care unit

OBJECTIVE

To determine the occurrence of inadequate antimicrobial therapy among critically ill patients with bacteremia and the factors associated with it, to identify the microorganisms that received inadequate antimicrobial treatment, and to determine the relationship between inadequate treatment and patients outcome.

METHODS

From June 1995 to January 1999 we collected data on all clinically significant ICU-bacteremias in our teaching hospital. Clinical and microbiological characteristics were recorded and the adequacy of empirical antimicrobial treatment in each case was determined. We defined inappropriate empirical antimicrobial treatment as applying to infection that was not being effectively treated at the time the causative microorganism and its antibiotic susceptibility were known. Multivariate analysis was used to determine the variables associated with inappropriate empirical antimicrobial treatment and to evaluate the influence of this on the related mortality to bacteremia, using the SPSS package (9.0).

RESULTS

Among 166 intensive care unit patients with bacteremia, 39 (23.5%) received inadequate antimicrobial treatment. In this last group the mean age of patients was 64.1 +/- 13.2 years, and 64% were men. Bacteremia was hospital-acquired in 92% of these cases. Eleven percent developed septic shock and 37.7% severe sepsis, and ultimately fatal underlying disease was present in 28.2% of patients given inadequate empirical antimicrobial treatment. The main sources of bacteremias in this group were: a vascular catheter (15.3%), respiratory (7.6%) or unknown (53.8%). The microorganisms most frequently isolated in the group with inadequate empirical antimicrobial treatment were: coagulase-negative staphylococci (29.5%), Acinetobacter baumannii (27.3%), Enterococcus faecalis, Pseudomonas aeruginosa, Enterobacter cloacae, Proteus mirabilis, Escherichia coli, and Candida species (4.5% each). The frequency of coagulase-negative staphylococci in the cases with inappropriate treatment was higher than in the group with appropriate treatment (OR 2.62; 95% CI: 1.10-6.21; P = 0.015). The global mortality rate was 56% and the related mortality was 30% in the group with inadequate empirical antimicrobial treatment. The only factor associated with inappropriate empirical antibiotic treatment was the absence of abdominal or respiratory focus (P = 0.04; OR = 0.35; 95% CI: 0.12-0.97). Septic shock was related to attributable mortality (P = 0.03; OR = 3.19; 95% CI: 1.08-9.40), but not inappropriate empirical antibiotic treatment (P = 0.24; OR = 1.71; 95% CI: 0.66-4.78).

CONCLUSION

Almost a quarter of critically ill patients with bloodstream infections were given inadequate empirical antibiotic treatment, but mortality was not higher in the group with inadequate treatment than in the group with adequate treatment. This fact was probably due to microbiological factors and clinical features, such as the type of microorganism most frequently isolated and the source of the bacteremia.

Evolution of serum lipids in two male bodybuilders using anabolic steroids

We followed weekly the evolution of serum lipid concentrations in two bodybuilders undergoing a cycle of treatment with anabolic steroids. These drugs caused maximum depression of high-density lipoprotein cholesterol concentrations by 69.1% in the fifth week after the beginning of the cycle for subject 1, and by 72.4% in the fourth week for subject 2. Maximum increases in low-density lipoprotein cholesterol concentrations were 144% and 156%, respectively. Total cholesterol and apolipoprotein (apo) B were highly increased with anabolic steroid use. We also saw depression of apo A-I by 84% and 91%, and lipoprotein(a) decreased to undetectable amounts in both cases. These effects were reversed 10 weeks after the end of the steroid cycle in subject 1, but subject 2 still presented abnormal concentrations of serum lipids 13 weeks after drug cessation. The periods until reversibility of anabolic steroid effects on lipids were longer than those reported in previous studies.

Evolution of serum lipids in two male bodybuilders using anabolic steroids

We followed weekly the evolution of serum lipid concentrations in two bodybuilders undergoing a cycle of treatment with anabolic steroids. These drugs caused maximum depression of high-density lipoprotein cholesterol concentrations by 69.1% in the fifth week after the beginning of the cycle for subject 1, and by 72.4% in the fourth week for subject 2. Maximum increases in low-density lipoprotein cholesterol concentrations were 144% and 156%, respectively. Total cholesterol and apolipoprotein (apo) B were highly increased with anabolic steroid use. We also saw depression of apo A-I by 84% and 91%, and lipoprotein(a) decreased to undetectable amounts in both cases. These effects were reversed 10 weeks after the end of the steroid cycle in subject 1, but subject 2 still presented abnormal concentrations of serum lipids 13 weeks after drug cessation. The periods until reversibility of anabolic steroid effects on lipids were longer than those reported in previous studies.

Effect of cell density on endothelin release from endothelial cells and phosphoramidon dependent inhibition

The modulation of endothelin (ET) release from endothelial cells was investigated as a function of cell density. The present study examined the release of ET from bovine pulmonary artery endothelial cells (BPAEC) and bovine aortic endothelial cells (BAEC) at various cell densities, as well as the effects of phosphoramidon, thiorphan and pepstatin on ET release at different densities. ET release from BPAEC and BAEC decreased as cell density increased. This cell density effect was not observed with prostacyclin release from either BPAEC or BAEC. Phosphoramidon (1 mM) inhibited ET release at every density examined for both BPAEC and BAEC. Thiorphan (1 mM) inhibited ET release from BPAEC weakly at low density and had no effect on ET release from BAEC. Pepstatin (1 mM) slightly inhibited ET release in BPAEC at the lowest density and had no effect at any other cell density for either cell type. These protease inhibitors had no effect on cell viability as determined by trypan blue exclusion and a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide conversion assay. This study supports the concept that ET release is modulated by endothelial cell density. In addition, these data demonstrate that phosphoramidon, which presumably inhibits the endothelin converting enzyme, can inhibit ET release over a range of cell densities without affecting cell viability.

Protective effect of N-acetylcysteine on ischaemia-induced myocardial damage in canine heart

The glutathione redox pathway is an important antioxidant system in the myocardium. N-Acetylcysteine is a low molecular weight glutathione precursor that has been used clinically to replenish glutathione stores. The present study was aimed at evaluating the protective effect of N-acetylcysteine on myocardial damage resulting from permanent coronary occlusion (without reperfusion) in anaesthetized dogs. N-Acetylcysteine (150 mg kg-1 i.v.) administered 2 min before occlusion reduced infarct size in dogs subjected to 24 h ischemia. The infarct size as a percentage of the area at risk was 86.8 +/- 3.6% (n = 11) in control (saline-treated) dogs and 68.2 +/- 2.4% (n = 7; P less than 0.05 vs control) in N-acetylcysteine-treated animals. Haemodynamic variables (heart rate, mean arterial pressure and rate-pressure product) were similar in the control and the treated group. Regional myocardial blood flow was determined with radioactive microspheres in ischaemic and non-ischaemic zones before occlusion and 3 h post-occlusion. N-Acetylcysteine did not influence the regional distribution of myocardial blood flow. The myocardial content of reduced glutathione was significantly (P less than 0.05) decreased 3 h post-occlusion (0.53 +/- 0.19 mumol/g-1; n = 5) compared to either pre-occlusion values (0.94 +/- 0.03 mumol/g-1; n = 8) or values 3 h post-occlusion in sham-operated animals (0.93 +/- 0.15 mumol/g-1; n = 5). Depletion of myocardial glutathione 3 h post-occlusion was not observed in dogs treated with N-acetylcysteine (0.87 +/- 0.11 mumol/g-1; n = 5).(ABSTRACT TRUNCATED AT 250 WORDS)

Heparin inhibits Na(+)-H+ exchange in vascular smooth muscle cells

Vascular smooth muscle cell proliferation has been shown to be an important factor in atheromatous plaque formation, hypertrophy associated with essential hypertension, and failure of balloon angioplasty procedures. Investigators have shown that a number of different agents stimulate vascular smooth muscle cell proliferation, including epidermal growth factor, platelet-derived growth factor, angiotensin II, and catecholamines. Previously, we have demonstrated that these agents also cause immediate changes in ion transport and second messenger generation in vascular smooth muscle cells. We have proposed that these immediate changes may be linked to each other and to cell proliferation. In contrast to the many agents that have been shown to stimulate vascular smooth muscle cell proliferation, only a few agents (e.g., heparin sodium or transforming growth factor-beta) have been shown to inhibit vascular smooth muscle cell proliferation. In the present study we have investigated whether heparin inhibits serum- or growth factor-stimulated changes in ion transport and second messenger generation in vascular smooth muscle cells. We found that heparin inhibits serum- or growth factor-stimulated Na(+)-H+ exchange in a concentration-dependent manner that is not dependent on the ability of heparin to function as an anticoagulant agent. In addition, other glycosaminoglycans were not found to be inhibitory, and the inhibitory effects of heparin were discovered to be limited to vascular smooth muscle cells. Heparin does not appear to be acting by binding to growth factors, or by directly inhibiting the Na(+)-H+ exchange protein. However, heparin did inhibit serum- or growth factor-stimulated inositol trisphosphate release and calcium mobilization.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of prolonged ethanol exposure on the glial fibrillary acidic protein-containing intermediate filaments of astrocytes in primary culture: a quantitative immunofluorescence and immunogold electron microscopic study

We investigated the effects of ethanol exposure on the shape of the cell and the morphology of intermediate filaments (IF) of cortical astrocytes in primary culture. The content and distribution of glial fibrillary acidic protein (GFAP), the major component of glial IF, was assessed using an anti-GFAP monoclonal antibody and fluorescence scanning densitometry together with quantitative pre- and post-embedding immunogold electron microscopy. The astrocytes were from 21-day-old fetuses obtained from both control and chronic alcoholic rats and were cultured for 28 days in the absence or presence of ethanol (25 mM). The main findings were: (a) ethanol-exposed astrocytes failed to develop processes or to acquire a filamentous IF distribution pattern; (b) these cells showed less GFAP than astrocytes without alcohol; (c) ethanol interfered with the reorganization of the anti-GFAP binding sites from clustered to random; and (d) astrocytes from alcohol-exposed fetuses cultured in the absence of ethanol also showed these alterations, suggesting initial damage to astrocyte precursor cells. Since the glial filaments play a crucial role in creating a scaffolding that guides neuronal migration, the effect of ethanol on astrocyte IF may possibly be correlated with the mechanisms underlying mental retardation and motor dysfunction which are characteristics of fetal alcohol syndrome.

Effect of single-dose aspirin on TXA2 and PGI2 cyclooxygenases in vivo

The present study investigated the sensitivities of the thromboxane A2 (TXA2) cyclooxygenase and the prostacyclin (PGI2) cyclooxygenase to aspirin using an in vivo animal model. In this model, arachidonic acid (AA) was administered to mice via cardiac puncture, and plasma levels of thromboxane B2 (TXB2) and 6-keto prostaglandin F1 alpha (6-keto PGF1 alpha) were determined. Infusion of AA (5, 10, 25 and 50 mg/kg) resulted in a dose-dependent increase in both TXB2 and 6-keto PGF1 alpha. Pretreatment with aspirin resulted in a dose-dependent and parallel decrease in TXB2 and 6-keto PGF1 alpha production. This nonselective inhibition occurred at all doses of aspirin (1, 10 and 50 mg/kg) and at all levels of cyclooxygenase activity (5-50 mg/kg AA). These results indicate that the TXA2 and PGI2 cyclooxygenase enzymes are equally sensitive to inhibition by a single dose of aspirin.

[Irradiation of the thyroid gland: changes in its function]

The authors have studied some usual parameters of the evaluation of the thyroid gland function, after secondary irradiation during tele-cobaltherapy treatment in 20 patients with larynx carcinoma. The parameters studied have been iodine uptake, Hamolsky index, T4, FT4 PB127I and cholesterol. The values, statistically treated, enable the conclusion that normal adult thyroid gland has a very low clinical and analytical radiosensibility.