In 10 patients with neurocysticercosis (NC), an assessment was made of the praziquantel (PZQ) concentration in the cerebrospinal fluid (CSF), in non-deproteinized serum and in protein-free serum: before administration of the drug and the 1st., 7th. and 21st. days of oral administration (50mg/kg/day during 21 days). Samples of CSF and blood were collected three hours after the last administration of the daily total dosage, on the 1st. and 21st. days; and from 2 to 6 hours after drug administration on the 7th. day. The total daily dosage was distributed into three equal parts of 1/3 each, with a 4 hours' interval between intakes, except in the last 5 cases, who on the 21st. day only were given the total daily dosage on a single administration. Results have shown dispersion in serum concentrations, which are similar to those seen in normal subjects as recorded in literature. There is a correlation between PZQ levels in the CSF and in the serum, the latter being very close to those found in protein-free serum fraction. The statistical treatment of results allowed the following considerations: PZQ concentrations in the CSF and in the protein free serum are in balance from the pharmacodynamic standpoint on the first day; this balance is maintained up to the 21st. day although at different levels from those seen on the 7th. day; on the 21st. day PZQ contents in CSF goes back to its similar values as recorded on the 1st. day, and this suggests that the participation of drug interaction factors has been reduced to non-significant levels. However, several factors can influence PZQ concentration in CSF, as absorption rate, liver first-pass effect and blood-brain barrier changes, and individual dose should be established for each patient based on drug concentration monitoring in the serum and/or in the CSF.
O comprometimento do sistema nervoso central (SNC) em micoses oportunistas, especialmente na criptococose, constitui capítulo cada vez mais angustiante dentre as infecções do encéfalo e leptomeninges.Tal fato se deve à gravidade da doença em si, à inexistência até o momento de drogas desprovidas de efeitos colaterais importantes limitando sua utilização e, ainda, a um aumento na incidência. Decorre este último, em grande parte, do número crescente de pacientes submetidos a condutas terapêuticas que favorecem a transformação de agentes oportunísticos em agentes patogênicos 3 » 5 ' 7 » 13 . Transplantados renais mantidos com imunossupressores e corticóides constituem o exemplo mais significativo quanto a esse aspecto. O número total de casos foi 18, tendo sido dois deles (casos 4 e 5) objeto de publicação anterior 9 A identificação dos pacientes, o tempo de internação, o ocorrência de óbitos e a concomitância de transplante renal, estão relacionados na tabela 1. Constam dessa mesmo tabela a terapêutica adotada em cada caso e as complicações respectivas.
In order to accomplish a model for immunosuppression in experimental conditions two lots of 50 young mice were divided into groups of 10, and submitted to dexamethasone ingestion. Two experiments were considered in the study. In the first experiment conditions for immunosuppression were established in 50 mice, by per os supply of several concentrations of dexamethasone in the water given for normal daily intake ad libitum. Criteria of immunosuppression considered include: hair standing on end; leukopenia by decrease of lymphocyte population; spleen atrophy in relation to controls, with severe hypoplasy of all lymphoid structures. In the second experiment another lot of 50 mice in similar conditions established for the first experiment and concerning the immunosuppression were submitted to intraperitoneal inoculation of near 10(6) Cryptococcus neoformans. Culture suspensions of cryptococci isolated from cerebrospinal fluid samples of human neurocryptococcosis cases were used for this purpose. Although fungi could be recognized in lungs, liver and spleen from every mice inoculated, only those with central nervous system involvement (near by an half of all) died. The discussion included considerations about the role of the blood-brain barrier function in the findings registered.
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