14 research outputs found
Correlation between oxidative stress and immunosuppressive therapy in renal transplant recipients with an uneventful postoperative course and stable renal function
Background Reactive oxygen species (ROS) are important mediators of
cellular damage and lipid peroxidation is the most important expression
of ROS-induced oxidative stress. Recent studies have suggested that
increased plasma malondialdehyde (MDA) levels are a consequence of
specific immunosuppressive therapies. This study aims at investigating
the relation between oxidative stress and immunosuppressive therapies in
renal transplant patients with stable renal function and uneventful
postoperative course.
Methods The study group included 26 renal patients. Two groups of renal
transplant recipients, treated with a different combination of
immunosuppressive agents were studied (Group A: CyA, MMF, Steroids and
Basiliximab, Group B: Tacrolimus, MMF, Steroids and Daclizumab). All
patients had an uneventful postoperative course. Plasma MDA levels were
measured before transplantation, 1 and 6 months after. Plasma
concentration of endogenous creatinine (Cr) was used as a measure of
stable renal function.
Results Levels of MDA were increased before the transplantation in all
renal patients (MDA: 7.81 +/- 4.81, normal levels: 2.23-1.08 nmol/ml, P
< 0.05). Combined therapy with CYA was associated with high values of
MDA at 6 months measurement after transplantation. However this tendency
of increased MDA levels did not achieve a statistical significance
(Group A: 6.97 vs. 9.06 nmol/ml, P > 0.05). On the contrary,
statistically significant diminution of MDA levels was observed in Group
B patients (Tacrolimus-MMF-steroids) at 6 months measurement after
transplantation. (Group B: 8.61 vs. 4.11 nmol/ml, P < 0.02 < 0.05).
Conclusions Immunosuppressive combined therapy with CyA was associated
with the high values of MDA that were measured posttransplantly. Our
study provides strong evidence that Tacrolimus is significantly
associated with improved free radical metabolism
The mechanical performance and histomorphological structure of the descending aorta in hyperthyroldism
Thyroid hormones decrease systemic vascular resistance by directly
affecting vascular smooth muscle relaxation. There is limited literature
about their effect on the mechanical performance of the aortic wall.
Therefore, the authors determined the influence of hyperthyroidism on
the mechanical properties and histomorphological structure of the
descending thoracic aorta in rats. Severe hyperthyroidism was induced in
20 male Wistar rats by administering L-thyroxine (T,) in their drinking
water for 8 weeks; agematched normal euthyroid rats acted as controls.
Animals were sacrificed, and the mechanical and histomorphometrical
characteristics of the descending thoracic aorta were studied. The
aortic wall of hyperthyroid rats was stiffer than that of euthyroid
animals at the upper physiologic levels of stress or strain (p < 0.05)
but less stiff at the lower physiologic and lower levels (p < 0.05). The
aorta of hyperthyroid animals compared with that of euthyroid ones
showed an increase of the internal and external diameters (p < 0.05),
the media area (p < 0.05), the number of smooth muscle cell nuclei (p <
0.05), and the collagen density (p < 0.05) and a decrease in the elastin
laminae thickness (p < 0.00 1) and elastin density (p < 0.00 1). In
hyperthyroid rats, the aortic wall was stiffer at the upper physiologic
and higher levels of stress and strain. These changes correlated with
microstructural changes of the aortic wall. The coexistence of
hyperthyroidism with disease states or clinical conditions that
predispose to increased arterial pressure may be associated with
increased arterial stiffness and have undesirable consequences on the
mechanical performance of the thoracic aorta and hemodynamic
homeostasis. These changes could lead to an increased risk for
developing vascular complications
Tigecycline in the treatment of infections from multi-drug resistant gram-negative pathogens
Objective: This observational retrospective study aims to present early
experience with tigecycline (TIG) in the treatment of infections due to
multi-drug resistant (MDR) microorganisms.
Methods: Adult patients included, received TIG for >5 days either as
monotherapy (M group) or as presumed active monotherapy (PAM group). In
the PAM group, all co-administered antimicrobial(s) were resistant in
vitro against the targeted pathogen(s) or had been clinically and
microbiologically failing after >5 days of therapy despite in vitro
susceptibility.
Results: Forty-five patients (35 in ICU) were treated for 28
Acinetobacter baumannii and 23 Klebsiella pneumoniae infections [21
ventilator-associated and healthcare-acquired pneumonia (VAP/HCAP), 10
bloodstream infections (BSI) and 14 surgical infections (SI)].
Successful overall clinical outcome was 80%, i.e. 81.8% in M group,
78.3% in PAM group, 90.5% in VAP/HCAP, 80% in BSI, 64.3% in SI and
85% in the cases with septic shock. Superinfections from
Enterobacteriaceae inherently resistant to tigecycline occurred in
31.8% of M and 13% of PAM group (p<0.001).
Conclusion: TIG represents a promising option in infections from MDR
pathogens, however, further clinical experience is required. (c) 2009
The British Infection Society. Published by Elsevier Ltd. All rights
reserved
Acute uncomplicated cystitis: from surveillance data to a rationale for empirical treatment
The objectives of this study were to explore the epidemiological
features and resistance rates in uropathogens isolated from cases of
acute uncomplicated cystitis (AUC) in Greece, and subsequently to guide
empirical treatment. Urine samples from outpatients aged > 16 years were
cultured and for each uropathogen isolated non-susceptibility to orally
administered antimicrobial agents was defined. Demographic and clinical
data were provided in questionnaire form. From January 2005 to March
2006 a total of 1936 non-duplicate positive urinary cultures were
collected and 889 AUC cases were evaluated. Escherichia coli was the
main aetiological agent (83%). In the AUC group, non-susceptibility
rates for E. coli isolates were as follows: amoxicillin 25.8%;
co-trimoxazole 19.2%; cefalothin 14.9%; nitrofurantoin 10.7%;
amoxicillin/clavulanic acid 5.2%; nalidixic acid 6%; mecillinam 3.4%;
ciprofloxacin 2.2%; cefuroxime 1.7%, and fosfomycin 1.6%. Amoxicillin
and/or co-trimoxazole use in the previous 3 months was significantly
associated with isolation of a co-trimoxazole-resistant E. coli isolate.
The same applied for previous use of a fluoroquinolone agent and
isolation of a ciprofloxacin-resistant E. coli isolate. In conclusion,
increased co-trimoxazole non-susceptibility rates undermine its use as a
first-line agent in empirical treatment, especially in cases of recent
use of co-trimoxazole and/or amoxicillin. Fluoroquinolones display
potent in vitro activity against community uropathogens, but prudent use
is warranted for uncomplicated infections. Mecillinam and nitrofurantoin
could serve as effective front-line agents in an effort to design
fluoroquinolones-sparing regimens. (c) 2009 Elsevier B.V. and the
International Society of Chemotherapy. All rights reserved
Effect of appropriate combination therapy on mortality of patients with bloodstream infections due to carbapenemase-producing Enterobacteriaceae (INCREMENT): a retrospective cohort study
The best available treatment against carbapenemase-producing Enterobacteriaceae (CPE) is unknown. The objective of this study was to investigate the effect of appropriate therapy and of appropriate combination therapy on mortality of patients with bloodstream infections (BSIs) due to CPE