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Biomedical subjects

S Nava

Publications and source records attributed to S Nava.

At least 19 recordsLinked to original sources
PubMed2006

Ticks (Ixodidae) on humans in South America.

Twenty eight species of Ixodidae have been found on man in South America (21 Amblyomma, 1 Boophilus, 2 Dermacentor, 2 Haemaphysalis, 1 Ixodes and 1 Rhipicephalus species). Most of them are rarely found on man. However, three species frequently parasitize humans in restricted areas of Argentina (A. neumanni reported from 46 localities), Uruguay (A. triste from 21 sites) and Argentina-Brazil (A. parvum from 27 localities). The most widespread ticks are A. cajennense (134 localities in Argentina, Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Paraguay, Suriname and Venezuela), A. ovale (37 localities in Argentina, Brazil, Ecuador, French Guiana, Guyana, Paraguay, Suriname and Venezuela) and A. oblongoguttatum (28 sites in Brazil, Colombia, French Guiana, Guyana, Suriname and Venezuela). Amblyomma aureolatum (18 localities in Argentina, Brazil, French Guiana and Paraguay), A. cajennense, and A. triste are vectors of rickettsioses to man in South America. A better understanding of the respective roles of these and other tick species in transmitting pathogens to humans will require further local investigations. Amblyomma ticks should be the main subjects of these studies followed by species of Boophilus, Dermacentor, Haemaphysalis and Rhipicephalus species. In contrast with North America, Europe and Asia, ticks of the genus Ixodes do not appear to be major players in transmitting diseases to human. Indeed, there is only one record of an Ixodes collected while feeding on man for all South America.

Animals↗
PubMed2006

The natural hosts of larvae and nymphs of Amblyomma tigrinum Koch, 1844 (Acari: Ixodidae).

The hosts of larvae and nymphs of Amblyomma tigrinum, a tick whose adults feed on wild and domestic Canidae in South America, are uncertain. A 17 months survey was carried out trapping wild vertebrates in north-western Córdoba, Argentina, to evaluate their parasitism with A. tigrinum subadults. Larvae and nymphs of this tick species were identified conventionally and by comparison of 16S rDNA sequences with GenBank deposited sequences. A total of 207 small and medium-sized rodents and 182 birds were captured and examined for ticks. Most ticks on birds were from ground forest feeding birds (BB) with a minimal contribution of birds feeding in open pastures. All ticks from rodents were obtained from representatives of the families Cricetidae (SR) and Caviidae (MR). Percent of larvae infestation was higher (P<0.01, Chi-square distribution) in BB (55.2%) and SR (46.4%) than in MR (17.4%) and the same trend was found for number of larvae on these hosts (test of Kruskal-Wallis). Caviidae (only representative Galea musteloides) rodents were extremely prone to be infested with nymphs of A. tigrinum (94.2%) followed by BB (50.6%) and SR (3.6%) (P<0.01) and the same tendency was found for number of nymphs (P<0.01). The index of aggregation for nymphs on MR was the lowest (0.409) followed by nymphs on BB (0.706) which may be a consequence of higher and homogenous exposure of G. musteloides to host-seeking nymphs. Several BB are food source for both larvae and nymphs of A. tigrinum while for rodents larvae were common only on SR (mainly on the Sigmodontinae Akodon dolores and Graomys sp.) and nymphs feed almost exclusively on MR. Therefore, both birds and rodents are of importance for the survival strategy of A. tigrinum subadults. The plasticity of A. tigrinum to colonize areas with different climates plus the capacity of their subadults to feed on hosts widely distributed indicates that this tick has the potential to become a widespread parasite but this does not seem to be the actual situation. Several proposals are presented to further understand its ecology.

Animals↗
PubMed2006

Maximal inspiratory and expiratory pressure measurement in tracheotomised patients.

The present study compared four different sites and conditions for the measurement of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) in 38 spontaneous breathing tracheotomised patients. Of the patients, 28 had chronic obstructive pulmonary disease (COPD). The four different conditions were: 1) through a cuff inflated cannula (condition A); 2) through the mouth with a deflated cannula (condition B); 3) through the mouth with a phonetic uncuffed cannula (condition C); and 4) through the mouth after stoma closure (condition D). Five trials in each condition were performed using a standardised method. The measurement of both MIP and MEP differed significantly depending on the condition of measurement. MIP taken in condition A was significantly higher when compared with conditions B, C and D. MEP in condition A was significantly higher when compared with condition B and D. In condition A the highest frequency of the best measurement of MIP and MEP was observed at the fourth and fifth effort, respectively. The same results were obtained after the selection of only COPD patients. In conclusion, respiratory muscle assessment differs significantly depending on measurement condition. Measurement through inflated cannula tracheotomy yields higher values of both maximal inspiratory and maximal expiratory pressure.

Aged↗
PubMed2005

Elemental characterization of PM10, PM2.5 and PM1 in the town of Genoa (Italy).

The particulate matter (PM) concentration and composition, the PM10, PM2.5, PM1 fractions, were studied in the urban area of Genoa, a coastal town in the northwest of Italy. Two instruments, the continuous monitor TEOM and the sequential sampler PARTISOL, were operated almost continuously on the same site from July 2001 to September 2004. Samples collected by PARTISOL were weighted to obtain PM concentration and then analysed by PIXE (particle induced X-ray emission) and by ED-XRF (energy dispersion X-ray fluorescence), obtaining concentrations for elements from Na to Pb. Some of the filters used in the TEOM microbalance were analysed by ED-XRF to calculate Pb concentration values averaged over 7-30 d periods.

Air Pollutants↗
PubMed2005

Identification of expandable human hepatic progenitors which differentiate into mature hepatic cells in vivo.

BACKGROUND: Liver diseases include a wide spectrum of both acute and chronic conditions which are associated with significant morbidity and mortality worldwide. Hepatocyte transplantation has therapeutic potential in the treatment of liver diseases, but its clinical use is hampered by the lack of donor tissue. Generation of hepatocytes in vitro from adult or fetal liver cell progenitors or, alternatively, identification of a progenitor population which in vivo can generate mature liver cells could solve this problem. METHODS: CD117+/CD34+/Lin- human fetal liver cells were isolated by magnetic cell sorting and expanded in culture. Both freshly isolated and in vitro expanded cells in various passages were studied for their ability to be functional in hepatic parenchyma following d-galactosamine (GalN) induced injury in nude C57 black mice. RESULTS: Freshly isolated and in vitro expanded CD117+/CD34+/Lin- cells, when transplanted intrasplenically into GalN treated mice, morphologically and functionally differentiated into hepatocytes and cholangiocytes. Human specific albumin, alpha fetoprotein, cytokeratin 19, and antitrypsin mRNA were expressed in mouse liver. In addition, the human progenitor cells expressed glucose-6-phosphatase, glycogen, albumin, gamma glutamyl transpeptidase, and dipeptidyl peptidase IV after transplantation. Expanded cells in various passages maintained their capacity to differentiate into functional liver cells. CONCLUSIONS: Fetal liver CD117+/CD34+/Lin- progenitors and their progeny proliferated in vitro and also functionally differentiated into mature hepatic cells in an acute liver injury model. Successful in vitro expansion of liver progenitor cells provides a basis for developing cell therapy strategies, metabolic and toxicity testing systems, and may serve as a vehicle for gene therapy.

Animals↗
PubMed2004

Sigmodontinae rodents as hosts for larvae and nymphs of Ixodes loricatus Neumann, 1899 (Acari: Ixodidae).

Larvae and nymphs of Ixodes loricatus Neumann, 1899 ticks (confirmed by morphological characters and by comparison of 16S mitochondrial rDNA sequences) were collected from Sigmodontinae Wagner, rodents in central and northern Argentina and Uruguay. A total of 100 larvae and 38 nymphs of I. loricatus were collected on the genera Akodon Meyen (n = 36 individuals), Calomys Waterhouse (n = 2), Oligoryzomys Bang in = 12), Oxymycterus Waterhouse (n = 9), and Scapteromys Waterhouse (n = 13). 72 larvae and 18 nymphs were collected on Akodon. Adults of I. loricatus were found in central Argentina and Uruguay on Didelphimorphia of the genera Didelphis Linnaeus and Lutreolina Thomas. Ixodes loricatus has been considered a species with strict total specificity to Didelphimorphia. Our results show that this statement may not be justified. Sigmodontinae rodents are sympatric and share habitats with the phylogenetically distant Didelphimorphia; infestation with I. loricatus seems to be its consequence. We tentatively consider I. loricatus moderately specific to Didelphimorphia.

Animals↗
PubMed2004

Effect of varying the pressurisation rate during noninvasive pressure support ventilation.

The aim of the study was to assess the effects of varying the pressurisation rate during noninvasive pressure support ventilation on patients' breathing pattern, inspiratory effort, arterial blood gases, tolerance to ventilation and amount of air leakage. A total of 15 chronic obstructive pulmonary disease patients recovering from an acute episode of hypercapnic acute respiratory failure were studied during four randomised trials with different levels of pressurisation rate. No significant changes were observed in breathing pattern and arterial blood gases between the different runs. The pressure time product of the diaphragm, an estimate of its metabolic consumption, was significantly lower with all pressurisation rates than with spontaneous breathing, but was significantly lowest with the fastest rate. However, air leak, assessed by the ratio between expired and inspired tidal volumes, increased and the patients' tolerance of ventilation, measured using a standardised scale, was significantly poorer with the fastest pressurisation rate. In chronic obstructive pulmonary disease patients recovering from an episode of acute hypercapnic respiratory failure and ventilated with noninvasive pressure support ventilation, different pressurisation rates resulted in different reductions in the pressure time product of the diaphragm; this reduction was greater with the fastest rate, but was accompanied by significant air leaks and poor tolerance.

Acute Disease↗
PubMed2004

Respiratory changes during defecation in patients with chronic respiratory failure.

Oxygen (O2) desaturation may occur in patients affected by respiratory diseases during daily activities, although most of these activities, e.g. walking, washing and cooking, can be avoided or eventually performed with an external aid. In this prospective study, the respiratory changes induced by the mandatory effort of defecation were assessed in patients with chronic respiratory insufficiency. Twenty-four consecutive patients with chronic respiratory failure due to obstructive or restrictive pulmonary disorders, showing a marked O2 desaturation during the 6-min walk test, were enrolled. Thirteen of them were already established on long-term O2 therapy (LTOT), while 11 were not. O2 saturation (Sa,O2), respiratory rate (RR), cardiac frequency (fC) and dyspnoea were measured at rest, and during and after defecation. Sa,O2 decreased significantly during defecation, while RR, fC and dyspnoea increased, both in the subgroup of patients without significant resting hypoxaemia and in the subgroup of patients receiving their usual resting flow of LTOT, as compared to resting values. In conclusion, the respiratory system of patients with chronic respiratory failure may be significantly strained by defecation.

Activities of Daily Living↗
PubMed2003

Orthopnea and inspiratory effort in chronic heart failure patients.

STUDY OBJECTIVE: Orthopnea is a typical feature of patients with chronic heart failure (CHF), the factors contributing to it are not completely understood. We investigated changes in dyspnea and other respiratory variables, induced by altering posture (from sitting to supine) in 11 CHF patients (NYHA classes II-IV) and 10 control subjects. METHODS AND RESULTS: We measured dyspnea (Borg scale) the diaphragm pressure time product per minute (PTPdi/m, index of metabolic consumption), and mechanical properties of the lung (lung compliance (C,L) and resistances (R,L). CHF patients also underwent a trial of non-invasive mechanical ventilation (NIMV) in the supine position in order to ascertain whether unloading the inspiratory muscles could somehow relieve dyspnea. While sitting the PTPdi/min was significantly higher in CHF patients than in controls (181 +/- 54 cm H2O x s/min vs. 96 +/- 32; P<0.05). Assuming a supine position caused no major changes in controls, whereas CHF patients showed a significant worsening in dyspnea, a rise in PTPdi/min (243 +/- 97 p<0.01) and R,L (4.7 +/- 1.2 cm H2O/L x s sitting vs. 7.9 +/- 2.5 supine; P<0.01) and a decrease in C,L (0.08 +/- 0.02 L/cm H2O sitting vs. 0.07 +/- 0.01 supine; P<0.05). Applying NIMV to supine CHF patients significantly reduced the PTPdi/min to 81 +/- 42 (P<0.001). Changes in dyspnea, produced by varying position or applying NIMV, were significantly correlated with PTPdi/min (r=0.80, P<0.005 and r=0.58, P<0.01, respectively). CONCLUSIONS: CHF patients had a higher PTPdi/min than controls when sitting, and assuming a supine position induced severe dyspnea, a large rise in R,L, and a reduction in C,L so that PTPdi/min increased further. Orthopnea was strongly correlated with the increased diaphragmatic effort.

Cardiac Output, Low↗
PubMed2002

Survival of mechanically ventilated patients admitted to a specialised weaning centre.

OBJECTIVE: Hospital mortality and survival rates of long-term ventilated patients.DESIGN. Retrospective cohort study. SETTING: Specialised national weaning centre. INTERVENTION: Protocol-directed liberation from ventilator. PATIENTS: Four hundred three of 640 patients with prolonged mechanical ventilation (MV) who were admitted to our respiratory intensive care unit (RICU) were studied. MV lasted longer than 2 weeks and patients had failed more than two weaning trials in the referring ICUs. The majority of patients (59.3%) had chronic obstructive pulmonary disease (COPD). RESULTS: After a mean duration of 41 days of MV prior to transfer, 68% of patients were liberated from the ventilator. In total, 98 of 403 patients (24.3%) died during the stay in our hospital, 305 patients (75.7%) were discharged. Compared to the non-survivors, the survivors were characterised by younger age, longer length of stay in our RICU, lower severity of illness scores at admission, fewer cardiac illnesses and a higher rate of weaning success. In 31.5% of the discharged patients non-invasive MV (NIV) was initiated during the stay at our unit. We gathered follow-up data on 293 patients (96.1%). Post-discharge survival rates were 67.6% at 3 months, 49.4% at 1 year and 38.1% at 3 years. Length of survival was significantly dependent on age, weaning success and main diagnosis (i.e., prognosis in COPD is worse compared to thoracic restriction, neuromuscular disease and others) in the multivariate analysis. CONCLUSIONS: Difficult-to-wean patients have a high hospital mortality rate and poor long-term prognosis. Age, main diagnosis, severity of illness, weaning success and institution of NIV predict survival.

Aged↗
PubMed2002

Where to perform noninvasive ventilation?

Noninvasive positive-pressure ventilation (NPPV) has been shown to be a means of reducing the need for endotracheal intubation, which when effective reduces the complication rate and improves outcome. Because paralysis and sedation are not needed and because the patient is not necessarily dependent upon a machine for respiration, ventilation outside the intensive care unit (ICU) is an option. A number of studies have shown that NPPV for acute exacerbations of chronic obstructive pulmonary disease (COPD) can be effective in the non-ICU environment, though usually in patients with less severe exacerbations. However, there have been no direct comparisons of the application of NPPV in different locations. The likelihood of success of the technique is an important factor in deciding there NPPV should be performed. Ready access to invasive ventilation is important when NPPV is not indicated from the outset or fails after an initial trial. In acute exacerbations of COPD, NPPV is less likely to be successful the more severe the exacerbation, as measured by the severity of acidosis. Good tolerance of NPPV, which translates into an improvement in pH and a fall in respiratory rate, predicts a successful outcome and is a useful way of monitoring progress. NPPV has been shown to be cost effective both in the ICU and when performed on general wards. A dedicated intermediate care unit with particular expertise in noninvasive modes of ventilation may provide the best environment, both in terms of outcome, but also cost effectiveness. The ideal location for noninvasive positive-pressure ventilation will vary from country to country and indeed from hospital to hospital, depending upon local factors. However, the most important factor is that staff be adequately trained in the technique and be available throughout the 24-h period.

Emergency Medical Services↗
PubMed2002

Noninvasive ventilation after intubation and mechanical ventilation.

Patients with chronic airflow obstruction who are difficult to wean from mechanical ventilation are at increased risk of intubation-associated complications and mortality because of prolonged invasive mechanical ventilation. Noninvasive positive pressure ventilation may revert most of the pathophysiological mechanisms associated with weaning failure in these patients. Several randomized controlled trials have shown that use of noninvasive ventilation to achieve earlier extubation in difficult-to-wean patients or in patients who develop respiratory failure after apparently successful extubation can result in reduced periods of endotracheal intubation and complication rates and improved survival. However, this is not a consistent finding, and the currently available published data with outcome as the primary variable are exclusively from patients who had pre-existing lung disease. In addition, the patients were haemodynamically stable, with a normal level of consciousness, no fever and a preserved cough reflex. It remains to be seen whether noninvasive positive pressure ventilation has a role in other patient groups and situations, such as prevention of postextubation failure or unplanned extubation. The technique is, however, a useful addition to the therapeutic armamentarium for a group of patients who pose a significant clinical and economic challenge.

Algorithms↗
PubMed2002

Weakness of respiratory and skeletal muscles after a short course of steroids in patients with acute lung rejection.

There have been occasional reports of acute respiratory and skeletal muscle weakness in intensive care unit patients treated with massive doses of corticosteroids. However, in this setting the concomitant use of other drugs may have influenced the finding. In this study the effects of 5 days of treatment with high doses of steroids in consecutive patients with acute lung rejection after transplantation were systematically evaluated. Maximal inspiratory pressure during phrenic nerve stimulation and peak torque of isokinetic contraction of the quadriceps and hamstring muscles were measured objectively. Compared to the pretreatment condition, approximately 45% of patients showed acute generalised muscle weakness that recovered after approximately 2 months. This demonstrates muscle weakness induced by steroids within patients.

Adrenal Cortex Hormones↗
PubMed2002

Muscle retraining in the ICU patients.

One of the most common causes of an ICU admission is a severe episode of acute respiratory failure due either to an exacerbation of chronic pulmonary disease or its ex-novo development after a surgical procedure, trauma or medical complications. These patients usually report, at admission to the ICU, a sedentary life before the acute episode, because the evolution of the disease is characterized by a progressive decline not only in respiratory function (e.g. FEV1), but also in the functional status, due to the effects of lack of exercise, drug administration, malnutrition and, later on, gas exchange abnormalities. Together with specific vital organ support, such as mechanical ventilation, patients admitted to an ICU may require other complex and integrated interventions in order to maintain the spared function and to prevent further damage. These interventions include nutritional and psychological support, counselling, nursing, prevention (e.g. to preserve skin integrity) and in particular a complete physiotherapic program, that may range from simple help to maintain a correct posture to complete recovery of walking autonomy.

Clinical Trials as Topic↗
PubMed2001

Physiological response to pressure support ventilation delivered before and after extubation in patients not capable of totally spontaneous autonomous breathing.

We designed a prospective, physiological study in 12 patients affected by chronic respiratory disorders. The study was aimed at assessing the diaphragm energy expenditure (PTPdi), lung resistance (RL) and elastance (EL), arterial blood gases (ABG), breathing pattern, and dyspnea measured by a visual analog scale during invasive pressure support ventilation (i-PSV) and noninvasive PSV (n-PSV). The ventilator settings were kept the same. Both i-PSV and n-PSV significantly reduced the PTPdi per minute, compared with that during a T-piece trial (204.4 +/- 93.8 cm H(2)O x s/min [i-PSV]; 197.5 +/- 119.8 [n-PSV]; 393.8 +/- 129.0 [T-piece]). Expired tidal volume (VTe) was significantly higher (p < 0.05) during n-PSV (615 +/- 166 ml) than during i-PSV (519 +/- 140 ml). The respiratory pump (PTPdi/VTe) was more effective (p < 0.05) with noninvasive ventilation (22.3 +/- 2.3 cm H(2)O x s/L for i-PSV versus 17.2 +/- 3.3 for n-PSV). RL and EL were similar with the two modes of ventilation. Overall dyspnea was significantly (p < 0.05) better during n-PSV than i-PSV, whereas ABG were similar. We have shown, in patients affected by stable chronic respiratory disorders not ready to sustain totally spontaneous breathing, that i-PSV and n-PSV are equally effective in reducing the PTPdi and in improving ABG, but that n-PSV seems to be better tolerated.

Acute Disease↗
PubMed2001

Diabetic rats transplanted with adult porcine islets and immunosuppressed with cyclosporine A, mycophenolate mofetil, and leflunomide remain normoglycemic for up to 100 days.

BACKGROUND: Transplantation of adult porcine islets (APIs) offers a possible means of treating diabetes. However, isolating APIs has been notoriously difficult. Furthermore, islet xenograft rejection must be prevented. MATERIALS AND METHODS: APIs were isolated by a modified automated method. API quality was assessed by static glucose stimulation (SGS), by transplantation to diabetic nude mice and by intraperitoneal glucose tolerance tests (IPGTTs). The morphologic characteristics of API xenograft rejection in rats were studied immunohistochemically. Furthermore, APIs were transplanted to diabetic rats that were either left untreated or immunosuppressed with cyclosporine A (CsA), mycophenolate mofetil (MMF) and leflunomide (LEF). B-glucose and porcine C-peptide levels were monitored and grafts were studied morphologically. RESULTS: Large numbers of APIs were isolated. At SGS, insulin release increased significantly. All nude mice transplanted with APIs were normoglycemic within 24 hr and remained so for up to 1 year. During IPGTTs, B-glucose levels were rapidly regulated to porcine levels. In untreated rats, API xenografts were destroyed within 6 days by a cellular infiltrate consisting mainly of macrophages. In untreated diabetic rats normoglycemia was sustained for 5.5+/-0.3 days. Rats immunosuppressed with CsA+MMF+LEF remained normoglycemic for 59.6+/-11.3 days. In 3 of 11 rats, normoglycemia was sustained for up to 101 days. Porcine C-peptide was detected in serum. At recurrence of hyperglycemia, many mononuclear cells were found close to the xenografts. However, only occasional cells infiltrated the grafts and many APIs were intact. CONCLUSIONS: Well-functioning APIs can be isolated in large numbers. API xenografts can be protected from rejection and can maintain an adequate function for up to 100 days, in rats immunosuppressed with CsA+MMF+LEF.

Animals↗