RESUMO
Delafloxacin is an investigational anionic fluoroquinolone antibiotic with broad-spectrum in vitro activity, including activity against Gram-positive organisms, Gram-negative organisms, atypical organisms, and anaerobes. The in vitro activity of delafloxacin and the percent microbiological response in subjects infected with fluoroquinolone-susceptible and nonsusceptible Staphylococcus aureus isolates were determined from two global phase 3 studies of delafloxacin versus vancomycin plus aztreonam in patients with acute bacterial skin and skin structure infections (ABSSSI). Patients from 23 countries, predominately the United States but also Europe, South America, and Asia, were enrolled. The microbiological intent-to-treat (MITT) population included 1,042 patients from which 685 S. aureus isolates were submitted for identification and susceptibility testing per CLSI guidelines at the central laboratory (JMI Laboratories, North Liberty, IA). The comparator fluoroquinolone antibiotics included levofloxacin and ciprofloxacin. Nonsusceptibility to these antibiotics was determined using CLSI breakpoints. S. aureus isolates were 33.7% levofloxacin nonsusceptible (LVX-NS). The delafloxacin MIC90 values against levofloxacin-nonsusceptible S. aureus, methicillin-resistant S. aureus (MRSA), and methicillin-susceptible S. aureus isolates were all 0.25 µg/ml. Delafloxacin demonstrated high rates of microbiological response against LVX-NS isolates as well as isolates with documented mutations in the quinolone resistance-determining region (QRDR). S. aureus was eradicated or presumed eradicated in 98.4% (245/249) of delafloxacin-treated patients. Similar eradication rates were observed for delafloxacin-treated subjects with levofloxacin-nonsusceptible S. aureus isolates (80/81; 98.8%) and MRSA isolates (70/71; 98.6%). Microbiological response rates of 98.6% were observed with delafloxacin-treated subjects with S. aureus isolates with the S84L mutation in gyrA and the S80Y mutation in parC, the most commonly observed mutations in global phase 3 studies. The data suggest that delafloxacin could be a good option for the treatment of infections caused by S. aureus isolates causing ABSSSI, including MRSA isolates, where high rates of ciprofloxacin and levofloxacin nonsusceptibility are observed. (The phase 3 studies described in this paper have been registered at ClinicalTrials.gov under identifiers NCT01984684 and NCT01811732.).
Assuntos
Antibacterianos/farmacologia , Fluoroquinolonas/farmacologia , Pele/microbiologia , Infecções Cutâneas Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/efeitos dos fármacos , Ásia , Método Duplo-Cego , Europa (Continente) , Humanos , Levofloxacino/farmacologia , Resistência a Meticilina/efeitos dos fármacos , Testes de Sensibilidade Microbiana/métodos , América do Sul , Infecções Cutâneas Estafilocócicas/microbiologiaRESUMO
The aim of this study was to identify the relative frequency of Huntington's disease (HD) and HD-like (HDL) disorders HDL1, HDL2, spinocerebellar ataxia type 2 (SCA2), SCA17, dentatorubral-pallidoluysian degeneration (DRPLA), benign hereditary chorea, neuroferritinopathy and chorea-acanthocytosis (CHAC), in a series of Brazilian families. Patients were recruited in seven centers if they or their relatives presented at least chorea, besides other findings. Molecular studies of HTT, ATXN2, TBP, ATN1, JPH3, FTL, NKX2-1/TITF1 and VPS13A genes were performed. A total of 104 families were ascertained from 2001 to 2012: 71 families from South, 25 from Southeast and 8 from Northeast Brazil. There were 93 HD, 4 HDL2 and 1 SCA2 families. Eleven of 104 index cases did not have a family history: 10 with HD. Clinical characteristics were similar between HD and non-HD cases. In HD, the median expanded (CAG)n (range) was 44 (40-81) units; R(2) between expanded HTT and age-at-onset (AO) was 0.55 (p=0.0001, Pearson). HDL2 was found in Rio de Janeiro (2 of 9 families) and Rio Grande do Sul states (2 of 68 families). We detected HD in 89.4%, HDL2 in 3.8% and SCA2 in 1% of 104 Brazilian families. There were no cases of HDL1, SCA17, DRPLA, neuroferritinopathy, benign hereditary chorea or CHAC. Only six families (5.8%) remained without diagnosis.
Assuntos
Coreia/genética , Demência/genética , Transtornos Heredodegenerativos do Sistema Nervoso/genética , Doença de Huntington/genética , Ataxias Espinocerebelares/genética , Adulto , Brasil , Coreia/diagnóstico , Coreia/epidemiologia , Coreia/patologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/genética , Transtornos Cognitivos/patologia , Demência/diagnóstico , Demência/epidemiologia , Demência/patologia , Feminino , Transtornos Heredodegenerativos do Sistema Nervoso/diagnóstico , Transtornos Heredodegenerativos do Sistema Nervoso/epidemiologia , Transtornos Heredodegenerativos do Sistema Nervoso/patologia , Humanos , Doença de Huntington/diagnóstico , Doença de Huntington/epidemiologia , Doença de Huntington/patologia , Masculino , Pessoa de Meia-Idade , Fenótipo , Ataxias Espinocerebelares/diagnóstico , Ataxias Espinocerebelares/epidemiologia , Ataxias Espinocerebelares/patologia , Expansão das Repetições de Trinucleotídeos/genéticaRESUMO
In order to evaluate age related changes of the elastic fiber system in the interfoveolar ligament, we studied the deep inguinal ring from 33 male cadavers aged from stillborn to 76 years. Selective and alternated staining methods for elastic fibers were performed to differentiate oxytalan, elaunin, and mature elastic fibers. We confirmed quantitative changes of the elastic fiber system with aging. There was a significant and progressive reduction of the oxytalan fibers (responsible for tissue resistance) and a significant increment in the mature elastic and elaunin fibers (responsible for tissue elasticity). Furthermore, there were structural changes in the thickness, shortness and curling of these mature elastic fibers. These changes induced loss of the elastic fiber function and loss of the interfoveolar ligament compliance. These factors predispose individuals to the development of indirect inguinal hernias that frequently emerge in adults and aged individuals, especially above the fifth decade.
Assuntos
Envelhecimento/patologia , Tecido Elástico/patologia , Fáscia/patologia , Ligamentos/patologia , Adolescente , Adulto , Fatores Etários , Idoso , Cadáver , Criança , Pré-Escolar , Hérnia Inguinal/patologia , Humanos , Lactente , Recém-Nascido , Canal Inguinal/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
A study was made of the dietary habits and intake of energy and nutrients of 127 elderly people aged between 65 and 95 (60 men and 67 women). The method employed involved the recording of food consumption over a period of five days. Subjects were divided into two groups according to body mass index: those who were overweight or obese (0) (BMI > or = 25 Kg/m2), who made up 60% of the experimental population, and those with normal bodyweight (NW) (BMI < 25 Kg/m2) (40%). The percentage of subjects who took no breakfast was somewhat higher amongst members of group 0 (5.6% compared to 3.9% of NW subjects). Further, the breakfast of 0 subjects was less varied, smaller and contributed less to daily energy intake and the covering of theoretical energy expenditure than did the breakfasts of NW subjects. 0 subjects also took less time over their breakfasts. More than half (58.8%) of NW subjects took what might be considered a satisfactory breakfast, i.e. this meal provided more than 20% of the total energy intake. Only 29.6% of 0 subjects took breakfasts of similar energetic value. NW subjects consumed greater quantities of sugars and fruits at breakfasts and also more carbohydrates, fibre, vitamin E and iron than did 0 subjects. The shorter length of time spent at breakfast by 0 subjects, their consumption of smaller and less varied breakfasts and the composition of the same, could indicate the existence of less healthy breakfast habits amongst the overweight and obese. This could be the reflection of inadequate food habits all round, or be a conditioning factor prompting 0 subjects to make poorer food choices for the rest of the day. Though some people omit breakfast in an attempt to control their weight, this is probably an inadvisable practice. The control of bodyweight might be more efficiently accomplished by taking an adequate breakfast and better distributing total calorie intake across the day, avoiding its concentration into one or two meals.
Assuntos
Envelhecimento , Índice de Massa Corporal , Ingestão de Alimentos , Ingestão de Energia , Idoso , Idoso de 80 Anos ou mais , Comportamento Alimentar , Feminino , Humanos , MasculinoRESUMO
In order to relieve complete obstruction of the thoracic esophagus due to spinocellular carcinoma, thirteen patients, all of them in good or at least regular general conditions were submitted to a bypass using a isoperistaltic gastric tube. The disease itself was treated by radiotherapy after surgery. Only one patient died at the hospital due to an error in the radiotherapy schedule. Cervical fistula was observed in six patients seven days after surgery; local treatment was enough for complete healing in five out of six. In one patient surgery was performed in order to repair the anastomotic area. Stenosis was observed in three patients but in all cases it was possible to overcome it by endoscopy. With the progress of the disease other complications were observed such as hemoptysis and respiratory distress. The survival rate was nine months (running between five and sixteen) but it should be noted that swallow capacity was maintained until death. The employed of a bypass of isoperistaltic gastric tube seems to be a desirable alternative in the treatment of esophageal cancer because it allows the reestablishment of deglutition before any treatment such as radiotherapy alone or combined with surgery.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagoplastia/métodos , Adulto , Idoso , Carcinoma de Células Escamosas/radioterapia , Neoplasias Esofágicas/radioterapia , Esofagoplastia/instrumentação , Feminino , Trânsito Gastrointestinal , Humanos , Masculino , Pessoa de Meia-Idade , Peristaltismo , Cuidados Pós-Operatórios , Complicações Pós-OperatóriasRESUMO
The authors report one case of peritoneal splenosis. The patient submitted to a gastrectomy had a past history of traumatic rupture of the spleen. The morphologic and immunologic aspects of splenosis are discussed. The value of imaging splenic tissue by scynthscanning are pointed out in basis of infection prophylaxis.