Cystic fibrosis with normal sweat chloride concentration: case report

Cystic fibrosis is a genetic disease usually diagnosed by abnormal sweat testing. We report a case of an 18-year-old female with bronchiectasis, chronic P. aeruginosa infection, and normal sweat chloride concentrations who experienced rapid decrease of lung function and clinical deterioration despite treatment. Given the high suspicion ofcystic fibrosis, broad genotyping testing was performed, showing a compound heterozygous with deltaF508 and 3849+10kb C->T mutations, therefore confirming cystic fibrosis diagnosis. Although the sweat chloride test remains the gold standard for the diagnosis of cystic fibrosis, alternative diagnostic tests such as genotyping and electrophysiologic measurements must be performed if there is suspicion of cystic fibrosis, despite normal or borderline sweat chloride levels.

Titanium pigment in tissues of drug addicts: report of 5 necropsied cases

The aim of this report is to describe the anatomic-pathologic findings from necropsies of 5 drug addicts with titanium pigment in several organs after chronic intravenous injection of crushed propoxyphene hydrochloride tablets. Samples from liver, spleen, lungs, lymph nodes, and bone marrow were obtained, and after being grossly studied, they were submitted to evaluation using common light and polarized microscopy. In all 5 cases, a pigment with characteristics of titanium dioxide was found within tissue samples of the organs studied. Our findings suggest that research concerning titanium pigment within body tissues should be enhanced, considering the potential contribution of this morphologic data to forensic pathology.

Princípios de terapêutica antibiótica na doença crítica

RESUMO: A infeção é frequente durante a doença crítica, quer como causa da doença crítica quer como complicação da sua evolução. Paradoxalmente, os avanços da medicina moderna aumentaram eles próprios o risco de infeção, ao permitir a sobrevida até idades avançadas, ao criar um novo grupo de doentes imunodeprimidos, nomeadamente doentes tratados com fármacos que interferem com as suas defesas naturais (corticóides, citostáticos), ao aumentar o tempo de vida de hospedeiros com comorbilidades debilitantes. Os antibióticos são um dos elos essenciais no tratamento da infeção. Contudo o seu uso também promove a seleção e crescimento de bactérias resistentes. Para além disso as doses convencionais de antibióticos foram selecionadas numa altura em que a resistência era um fenómeno raro e podem não ser atualmente as mais adequadas. Existe hoje muita evidência acumulada que os doentes críticos sofrem alterações da sua farmacocinética (PK) que podem facilitar a ocorrência de falência terapêutica ou de toxicidade tanto por sub como por sobredosagem de antibióticos. Essas alterações são complexas e difíceis de estudar. Finalmente, também a farmacodinâmica (PD) dos antibióticos pode estar alterada nesta população, podendo haver necessidade de ajustar os alvos terapêuticos de forma individual. O objetivo deste trabalho foi investigar a relação entre a terapêutica antibiótica, as suas características PK e PD, a carga bacteriana e o prognóstico dos doentes críticos. O plano de investigação incluiu: 1. Dados da epidemiologia portuguesa de doentes críticos com infeção; 2. Avaliação da relação entre a carga bacteriana, o tempo até ao início do tratamento antibiótico e o prognóstico dos doentes críticos; 3. Avaliação da evolução da PK durante o tratamento da infeção; 4. Um estudo multicêntrico para avaliação da eficácia da terapêutica com um β- lactâmico doseado de acordo com a relação PK/PD. Na introdução é descrita a importância dos antibióticos, a sua origem e o problema crescente das resistências bacterianas relacionadas com o seu emprego e abuso. É salientada a importância de racionalizar a posologia, de acordo com os conceitos de PK e de PD. No Capítulo 1 são apresentados dados de epidemiologia portuguesa de infeção em doentes críticos, sobretudo retirados de dois estudos prospetivos, observacionais, os quais incluíram mais de 50% da capacidade de internamento em cuidados intensivos existente em Portugal. No Capítulo 2 são descritos os conceitos de PK e as suas alterações nos doentes críticos. De seguida são revistos os conceitos de PD de antibióticos e a sua aplicação a esta população, em particular durante as infeções graves (Capítulo 3). Nos capítulos seguintes são aprofundadas estas alterações da PK nos doentes críticos e as suas causas, de forma a destacar a importância da monitorização da concentração dos antibióticos. São apresentados os dados duma revisão sistemática de PK de antibóticos nesta população (Capítulo 4), pormenorizadas as alterações da PD que comprometem a eficácia da terapêutica antibiótica, facilitam o desenvolvimento de resistências e podem levar a falência terapêutica (Capítulo 5). Consequentemente a compreensão global destas alterações, da sua relevância clínica e a revisão da evidência disponível facilitou o desenvolvimento do próprio plano global de investigação (Capítulos 6 e 7). No Capítulo 6.1 são descritos os antibióticos tempo-dependente e a importância de aumentar o seu tempo de perfusão. Foi desenhado um estudo multicêntrico para comparar a eficácia e segurança da perfusão contínua da piperacilina tazobactam (um antibiótico β-lactâmico associado a um inibidor de β-lactamases) com a mesma dose do antibiótico, administrado em dose convencional, intermitente. A importância de dosear corretamente os antibióticos concentração-dependente foi também avaliada num estudo a primeira dose dos aminoglicosídeos (Capítulo 6.2). Outras estratégias para melhorar os resultados assistenciais dos doentes infetados são abordadas no Capítulo 7, em particular a importância da terapêutica antibiótica precoce, a avaliação da carga bacteriana e a compreensão da variação da PK ao longo do tratamento da infeção. Foi desenvolvido um algoritmo de abordagem terapêutica que incluiu estas alterações da PK e da PD nos doentes críticos. Finalmente no Capítulo 8 são descritos mecanismos de desenvolvimento das resistências bacterianas bem como estratégias para a sua abordagem. O Capítulo final (Capítulo 9) aponta um plano para futuras áreas de trabalho. O elemento chave identificado neste trabalho de investigação é o reconhecimento da variabilidade significativa da PK dos antibióticos durante a doença crítica, a qual condiciona a sua posologia. Estas alterações estão relacionadas com a própria gravidade da doença e tendem a diminuir ao longo do seu tratamento. No entanto nem a gravidade da doença nem as características individuais as permitem prever de forma aceitável pelo que a utilização duma posologia universal, independente da situação clínica concreta, pode ser inadequada. As estratégias para melhorar os resultados assistenciais dos doentes críticos infetados devem ser baseadas na individualização da posologia antibiótica de acordo com os princípios da PK e da PD, preferencialmente apoiadas em doseamentos da sua concentração. ------------------------------------ ABSTRACT: Infection commonly occurred during critical illness, either as a cause or complicating the course of the disease. Advances in medicine had paradoxically increase the risk of infection, both by improving survival to older ages and by introducing a new group of immunosuppressed patients, those who are treated with drugs that interfere with their natural defenses (corticosteroids, cytostatics) and those who survived longer with aggressive diseases. Antibiotics are of paramount importance for treating infection. However the use of these drugs also promote the selection and growth of resistant bacteria. Furthermore conventional antibiotic doses were calculated for less severe patients during a time when resistance was rare. Nowadays there is increasing evidence that critically ill patients experiment altered pharmacokinetics (PK) that may lead to therapeutic failure and/or drug toxicity. Equally, such PK alterations are complex and challenging to investigate. Finally pharmacodynamics (PD) may also be different in this population and antibiotic targets may need to be tailored to the individual patient. The aim of this research was to investigate the relationship between antibiotic therapy, its PK and PD, bacterial burden and critically ill patients outcomes. The research plan comprised of: 1. Epidemiological portuguese data of critically ill infected patients; 2. Relationship between burden of bacteria, time until the start of antibiotics and patient outcomes; 3. Evaluation of PK during treatment of infection; 4. A multicentre study evaluating PK guided β-lactam therapy. The introductory chapter outlines the importance of antibiotics, its origins, the problem of increasing bacteria resistance, related to its use and overuse and the importance of rational drug dosing using PK and PD concepts. In Chapter 1 portuguese epidemiological data of infections in critically ill patients is presented, mostly coming from two prospective observational studies, encompassing more than 50% of critically ill beds available in Portugal. Chapter 2 describes the concepts of PK and the changes occurring in critically ill patients. This is followed by a review of the concepts of PD of antibiotics and its application to this population, especially during severe infections (Chapter 3). In the following chapter these changes in antibiotics PK in critical illness are and its causes are detailed, to outline the importance of therapeutic drug monitoring. Data on a systematic review of antibiotics PK in those patients is provided (Chapter 4). The following chapter (Chapter 5) elucidates important changes in PD, that compromises antibiotic therapy, facilitate the occurrence of resistance and may lead to therapeutic failure. Thus, an understanding of the clinical problem and available evidence facilitated the development of a comprehensive research plan (Chapter 6 and Chapter 7). Chapter 6.1 describes time-dependent antibiotics and the importance of extending its perfusion time. A multicenter study was designed to compare the continuous infusion of piperacillin tazobactam (a β-lactam antibiotic) with the same daily dose, prescribed in a conventional, intermittent dose. The importance of correct dosing of antibiotics was also assessed through a study addressing aminoglycoside (a concentration-dependent antibiotic) therapy (Chapter 6.2), focusing on its first dose. Strategies to improve severe infected patients outcomes were addressed in Chapter 7, namely the importance of early antibiotic therapy, assessing the burden of bacteria and understanding changes in antibiotic concentration during the course of infection. An algorithm to include all the described changes in both PK and PD of critically ill patients was developed. Finally in Chapter 8 mechanisms of the increasing resistance of bacteria are described and strategies to address that problem are proposed. The closing chapter (Chapter 9) lays a roadmap for future work. The key finding of this research is the significant variability of the antibiotics PK during critical illness, which makes dosing a challenging issue. These changes are related to the severity of the infection itself and improve through the course of the disease. However neither disease severity nor individual characteristics are useful to predict PK changes. Therefore, the use of a universal dose approach, regardless of the individual patient, may not be the best approach. Strategies to improve patients’ outcomes should be based on tailoring antibiotics to the individual patient, according to PK and PD principles, preferentially supported by therapeutic drug monitoring.

Contribution to drug discovery and development for tauopathies using yeast as a model

This work aimed to contribute to drug discovery and development (DDD) for tauopathies, while expanding our knowledge on this group of neurodegenerative disorders, including Alzheimer’s disease (AD). Using yeast, a recognized model for neurodegeneration studies, useful models were produced for the study of tau interaction with beta-amyloid (Aβ), both AD hallmark proteins. The characterization of these models suggests that these proteins co-localize and that Aβ1-42, which is toxic to yeast, is involved in tau40 phosphorylation (Ser396/404) via the GSK-3β yeast orthologue, whereas tau seems to facilitate Aβ1-42 oligomerization. The mapping of tau’s interactome in yeast, achieved with a tau toxicity enhancer screen using the yeast deletion collection, provided a novel framework, composed of 31 genes, to identify new mechanisms associated with tau pathology, as well as to identify new drug targets or biomarkers. This genomic screen also allowed to select the yeast strain mir1Δ-tau40 for development of a new GPSD2TM drug discovery screening system. A library of unique 138 marine bacteria extracts, obtained from the Mid-Atlantic Ridge hydrothermal vents, was screened with mir1Δ-tau40. Three extracts were identified as suppressors of tau toxicity and constitute good starting points for DDD programs. mir1Δ strain was sensitive to tau toxicity, relating tau pathology with mitochondrial function. SLC25A3, the human homologue of MIR1, codes for the mitochondrial phosphate carrier protein (PiC). Resorting to iRNA, SLC25A3 expression was silenced in human neuroglioma cells, as a first step towards the engineering of a neural model for replicating the results obtained in yeast. This model is essential to understand the mechanisms of tau toxicity at the mitochondrial level and to validate PiC as a relevant drug target. The set of DDD tools here presented will foster the development of innovative and efficacious therapies, urgently needed to cope with tau-related disorders of high human and social-economic impact.

FOOD CONCENTRATION AND TEMPERATURE EFFECTS ON LIFE CYCLE CHARACTERISTICS OF TROPICAL CLADOCERA (Daphnia gessneri Herbst, Diaphanosoma sarsi Richard, Moina reticulata (Daday)): I. DEVELOPMENT TIME

The effects of food concentration and temperature on embryonic and postem-bryonic duration of three tropical species, Daphnia gessneri(1.5mm), Diaphanosoma sarsi(1.2mm) and Moina reticulata(0.8mm), were investigated as part of life cycle studies which included growth, body size and reproduction. These are the very first experimental studies undertaken on these species. The long-term growth experiments were performed under controlled laboratory conditions at all combinations of temperature (22"C, 27"C and 32"C) and constant food concentration (0.03, 0.05, 0.10, 0.25, 0.50 and 1.00 mgC/L) of the unicellular green alga Scenedesmus acutus.Animals were examined twice daily throughout their life cycle from the neonate to third adult instar. In all three species, temperature exerted the most powerful influence on embryonic duration but there was also a smaller food effect. In D. gessneri,postembry-onic durations remained more or less the same at food levels 0.25 mgC/L but were influenced by temperature. At food concentrations of 0.1 mgC/L or lower, postembryonic durations became increasingly prolonged, particularly at high temperatures. This threshold concentration is affected by temperature: in D. gessneri,it was 0.1 mgC/L at 22oC and 27oC but higher at 32oC (between 0.25 and 0.50 mgC/L). At the same temperature of 27oC, the food threshold level varied between species: it was higher (0.25 mgC/L) for D. sarsiand lower (0.05 mgC/L) for M. reticulatacompared with D. gessneri(0.1 mgC/L). In both embryonic and postembryonic durations there is a body size effect as the absolute durations were longest in the largest species and shortest in the smallest species In all three species, prolongation of postembryonic duration at combinations of high temperature and lowered food levels was accompanied by increased number of juvenile instars.

Assessment of liposome disruption to quantify drug delivery in vitro

Efficient liposome disruption inside the cells is a key for success with any type of drug delivery system. The efficacy of drug delivery is currently evaluated by direct visualization of labeled liposomes internalized by cells, not addressing objectively the release and distribution of the drug. Here, we propose a novel method to easily assess liposome disruption and drug release into the cytoplasm. We propose the encapsulation of the cationic dye Hoechst 34,580 to detect an increase in blue fluorescence due to its specific binding to negatively charged DNA. For that, the dye needs to be released inside the cell and translocated to the nucleus. The present approach correlates the intensity of detected fluorescent dye with liposome disruption and consequently assesses drug delivery within the cells.

Influence of glucose concentration on the structure and quantity of biofilms formed by Candida parapsilosis

Candida parapsilosis is nowadays an emerging opportunistic pathogen and its increasing incidence is part related to the capacity to produce biofilm. In addition, one of the most important C. parapsilosis pathogenic risk factors includes the organisms\textquoteright selective growth capabilities in hyper alimentation solutions. Thus, in this study, we investigated the role of glucose in C. parapsilosis biofilm modulation, by studying biofilm formation, matrix composition and structure. Moreover, the expression of biofilm-related genes (BCR1, FKS1 and OLE1) were analyzed in the presence of different glucose percentages. The results demonstrated the importance of glucose in the modulation of C. parapsilosis biofilm. The concentration of glucose had direct implications on the C. parapsilosis transition of yeast cells to pseudohyphae. Additionally, it was demonstrated that biofilm related genes BCR1, FKS1 and OLE1 are involved in biofilm modulation by glucose. The mechanism by which glucose enhances biofilm formation is not fully understood, however with this study we were able to demonstrate that C. parapsilosis respond to stress conditions caused by elevated levels of glucose by up-regulating genes related to biofilm formation (BCR1, FKS1 and OLE1).

Poly(vinylidene fluoride-trifluoroethylene)/NAY zeolite hybrid membranes as a drug release platform applied to ibuprofen release

Poly(vinylidene fluoride-trifluoroethylene)/NaY zeolite composite membranes were prepared by solvent casting and evaluated as a suitable drug release platform through the evaluation of loading and release of ibuprofen. The membranes were characterized at the morphological, structural and mechanical levels. The 1H-NMR spectra indicate that only the membranes with 16 and 32 % of NaY were useful for IBU encapsulation and the drug release was followed by UV-Vis spectroscopy. The release profile is independent of the zeolite content and can be described by the Korsmeyer-Peppas model. The membrane with 32 % zeolite content releases more than double IBU amount when compared with the membrane with 16 % showing that zeolite content allows tailoring membrane drug release content for specific applications. The drug release platform developed in this work is suitable for other drugs and applications.

On line pre-concentration for simultaneous determination of low molecular weight organic acids and inorganic anions in Amazonian river water samples employing ion chromatography with conductivity detection

An ion chromatography procedure, employing an IonPac AC15 concentrator column was used to investigate on line preconcentration for the simultaneous determination of inorganic anions and organic acids in river water. Twelve organic acids and nine inorganic anions were separated without any interference from other compounds and carry-over problems between samples. The injection loop was replaced by a Dionex AC15 concentrator column. The proposed procedure employed an auto-sampler that injected 1.5 ml of sample into a KOH mobile phase, generated by an Eluent Generator, at 1.5 mL min-1, which carried the sample to the chromatographic columns (one guard column, model AG-15, and one analytical column, model AS15, with 250 x 4mm i.d.). The gradient elution concentrations consisted of a 10.0 mmol l-1 KOH solution from 0 to 6.5 min, gradually increased to 45.0 mmol l-1 KOH at 21 min., and immediatelly returned and maintained at the initial concentrations until 24 min. of total run. The compounds were eluted and transported to an electro-conductivity detection cell that was attached to an electrochemical detector. The advantage of using concentrator column was the capability of performing routine simultaneous determinations for ions from 0.01 to 1.0 mg l-1 organic acids (acetate, propionic acid, formic acid, butyric acid, glycolic acid, pyruvate, tartaric acid, phthalic acid, methanesulfonic acid, valeric acid, maleic acid, oxalic acid, chlorate and citric acid) and 0.01 to 5.0 mg l-1 inorganic anions (fluoride, chloride, nitrite, nitrate, bromide, sulfate and phosphate), without extensive sample pretreatment and with an analysis time of only 24 minutes.

Spatial-temporal modellization of the NO2 concentration data through geostatistical tools

The nitrogen dioxide is a primary pollutant, regarded for the estimation of the air quality index, whose excessive presence may cause significant environmental and health problems. In the current work, we suggest characterizing the evolution of NO2 levels, by using geostatisti- cal approaches that deal with both the space and time coordinates. To develop our proposal, a first exploratory analysis was carried out on daily values of the target variable, daily measured in Portugal from 2004 to 2012, which led to identify three influential covariates (type of site, environment and month of measurement). In a second step, appropriate geostatistical tools were applied to model the trend and the space-time variability, thus enabling us to use the kriging techniques for prediction, without requiring data from a dense monitoring network. This method- ology has valuable applications, as it can provide accurate assessment of the nitrogen dioxide concentrations at sites where either data have been lost or there is no monitoring station nearby.

Prediction of drug targets in human pathogens

The identification of new and druggable targets in bacteria is a critical endeavour in pharmaceutical research of novel antibiotics to fight infectious agents. The rapid emergence of resistant bacteria makes today's antibiotics more and more ineffective, consequently increasing the need for new pharmacological targets and novel classes of antibacterial drugs. A new model that combines the singular value decomposition technique with biological filters comprised of a set of protein properties associated with bacterial drug targets and similarity to protein-coding essential genes of E. coli has been developed to predict potential drug targets in the Enterobacteriaceae family [1]. This model identified 99 potential target proteins amongst the studied bacterial family, exhibiting eight different functions that suggest that the disruption of the activities of these proteins is critical for cells. Out of these candidates, one was selected for target confirmation. To find target modulators, receptor-based pharmacophore hypotheses were built and used in the screening of a virtual library of compounds. Postscreening filters were based on physicochemical and topological similarity to known Gram-negative antibiotics and applied to the retrieved compounds. Screening hits passing all filters were docked into the proteins catalytic groove and 15 of the most promising compounds were purchased from their chemical vendors to be experimentally tested in vitro. To the best of our knowledge, this is the first attempt to rationalize the search of compounds to probe the relevance of this candidate as a new pharmacological target.

Mercury and methylmercury concentration assessment in children's hair from Manaus, Amazonas state, Brazil

The present study evaluated Hg and MeHg content in hair samples of 201 children 2 to 7 years old, living in six neighborhoods of the city of Manaus, Amazonas State, Brazil. In general, the total Hg and MeHg median ranges in hair were similar (0.91 to 1.71 mg kg-1) except for the São Jose neighborhood, which was lower (0.16 mg kg-1). De spite the fact that the Manaus population consumes fish as part of the normal dietary intake, the Hg hair levels were below the level for an adult population not exposed to mercury (2.0 mg kg-1). These data were compared to demographic, socioeconomic information and eating habits of the families that took part in the study. The results were also compared to other published data from the Amazon region, other regions of Brazil and other countries. Future studies to set Hg and MeHg levels in hair of children in Brazil should take into account and assess the diversity of the country, mainly in terms of eating habits, socio-economic and cultural aspects.

Microstructural evolution of Au/TiO2 nanocomposite films: The influence of Au concentration and thermal annealing

Nanocomposite thin films consisting of a dielectric matrix, such as titanium oxide (TiO2), with embedded gold (Au) nanoparticles were prepared and will be analysed and discussed in detail in the present work. The evolution of morphological and structural features was studied for a wide range of Au concentrations and for annealing treatments in air, for temperatures ranging from 200 to 800 °C. Major findings revealed that for low Au atomic concentrations (at.%), there are only traces of clustering, and just for relatively high annealing temperatures, T ≥ 500 °C. Furthermore, the number of Au nanoparticles is extremely low, even for the highest annealing temperature, T = 800 °C. It is noteworthy that the TiO2 matrix also crystallizes in the anatase phase for annealing temperatures above 300 °C. For intermediate Au contents (5 at.% ≤ CAu ≤ 15 at.%), the formation of gold nanoclusters was much more evident, beginning at lower annealing temperatures (T ≥ 200 °C) with sizes ranging from 2 to 25 nm as the temperature increased. A change in the matrix crystallization from anatase to rutile was also observed in this intermediate range of compositions. For the highest Au concentrations (> 20 at.%), the films tended to form relatively larger clusters, with sizes above 20 nm (for T ≥ 400 °C). It is demonstrated that the structural and morphological characteristics of the films are strongly affected by the annealing temperature, as well as by the particular amounts, size and distribution of the Au nanoparticles dispersed in the TiO2 matrix.

Delivery as nanoparticles reduces imatinib mesylate-induced cardiotoxicity and improves anticancer activity

Clinical effectiveness of imatinib mesylate in cancer treatment is compromised by its off-target cardiotoxicity. In the present study, we have developed physically stable imatinib mesylate-loaded poly(lactide-co-glycolide) nanoparticles (INPs) that could sustainably release the drug, and studied its efficacy by in vitro anticancer and in vivo cardiotoxicity assays. MTT (methylthiazolyldiphenyl-tetrazolium bromide) assay revealed that INPs are more cytotoxic to MCF-7 breast cancer cells compared to the equivalent concentration of free imatinib mesylate. Wistar rats orally administered with 50 mg/kg INPs for 28 days showed no significant cardiotoxicity or associated changes. Whereas, increased alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase levels, and reduced white blood cell, red blood cell, and hemoglobin content were observed in the animals administered with free drug. While the histological sections from hearts of animals that received INPs did not show any significant cardiotoxic symptoms, loss of normal architecture and increased cytoplasmic vacuolization were observed in the heart sections of animals administered with free imatinib mesylate. Based on these results, we conclude that nano-encapsulation of imatinib mesylate increases its efficacy against cancer cells, with almost no cardiotoxicity.

In vitro and in vivo studies of temozolomide loading in zeolite structures as drug delivery systems for glioblastoma

Zeolites Y (faujasite) and MOR (mordonite) were used as hosts for temozolomide (TMZ), a current good-standard chemotherapeutic agent used in the treatment of glioblastoma brain tumors. TMZ was loaded into zeolites by liquid-phase adsorption at controlled pH. FTIR, 1H NMR, MS, SEM, UV/vis and chemical analysis demonstrated the successful loading of TMZ into zeolite hosts. The hydrolysis of TMZ in MTIC (TMZ metabolite) after the preparation of drug delivery systems (DDS) was observed in simulated body fluid. The effect of zeolites and DDS were evaluated on the viability of glioblastoma cell lines. Unloaded Y zeolite presented toxicity to cancer cells in contrast to MOR. In accordance, the best results in potentiation of the TMZ effect was obtained with MOR. We found that mordonite loaded with 0.026 mmol of TMZ was able to decrease the half maximal inhibitory concentrations (IC50) at least 3-fold in comparison to free temozolomide both in vitro and in vivo.