ABSTRACT
Objective To evaluate the efficacy of isolated ultrafiltration (IUF) for patients with cardiac insufficiency after acut emyocardial infarction (AMI).Methods The acut emyocardial infarction patients admitted from August 2010 to August 2014 were recruited for study.After primary percutaneous coronary intervention (PCI),102 patients presented cardiac insufficiency taking the form of hypotension and acute left heart failure.All heart failure patients dealt with routine medications at first,and were then randomly (random number) divided into two groups,group A was routine medication group and group B was isolated ultrafiltration after routine medication group.Data recorded at different intervals in the same group were analyzed by ANOVA.Data recorded from two groups at the same intervals were analyzed by t test.Data of mortality in the two groups were analyzed by x2 test.P value less than 0.05 was considered statistically significant.Results Of them,51 patients were treated with routine medication resulting in gradual improvement of cardiac function,but the improvement was slower compared with the isolated ultrafiltration group.Other 51 patients were treated with isolated ultrafiltration,and isolated ultrafiltration was discontinued in 2 patients owing to progressive thrombocytopenia and in another one patient owing to systolic blood pressure below 90 mmHg,with clinical manifestations of organ hypoperfusion,poor peripheral circulation,cool clammy skin and oliguria.In the rest of 48 patients in the isolated ultrafiltration group,vital signs were stable,and heart failure symptoms and serum electrolytes improved significantly (P ＜0.05).After one week of using isolated ultrafiltration,left ventricular ejection fraction (LVEF) also improved (P ＜ 0.05).The differences in mortality within one month,the mean ICU stay,the mean hospitalized stay,and the rate of recurrent heart failure were significant between the two groups (P ＜ 0.05)Conclusions The isolated ultrafiltration is a relatively safe and effective strategy for patients with cardiac insufficiency and hypotension after acut emyocardial infarction.
ABSTRACT
Com o objetivo de comprovar se doses não tóxicas repetidas de Palicourea aeneofusca (Müll. Arg.) Standl. criam resistência à intoxicação, 12 caprinos foram distribuídos aleatoriamente em dois grupos experimentais de seis animais cada. No Grupo 1 foi induzida resistência mediante a administração, durante quatro períodos alternados, de 0,02g/kg das folhas dessecadas de P. aeneofusca durante 5 dias, 0,02g/kg durante 5 dias, 0,03g/kg durante 5 dias e 0,03g/kg por mais 5 dias. Entre o primeiro e o segundo período de administração e entre o segundo e o terceiro período os animais não receberam planta por 10 dias consecutivos e entre o terceiro e quarto período de administração os animais permaneceram 15 dias sem ingerir a planta. Um caprino morreu subitamente quando estava recebendo 0,03 g/kg da planta, no terceiro período de administração. O Grupo 2 não foi adaptado ao consumo de P. aeneofusca. Quinze dias após a adaptação ao consumo de P. aeneofusca do Grupo 1, os dois grupos receberam P. aeneofusca na dose diária de 0,03g/kg durante 19 dias. A partir do 20º dia de administração continuada a dose diária de P. aeneofusca foi aumentada para 0,04g/kg. Esta dose foi administrada por mais 12 dias. Os animais que mostraram sinais clínicos foram retirados do experimento imediatamente após a observação dos primeiros sinais. Um caprino do Grupo 2 apresentou sinais clínicos de intoxicação e morreu no 12º dia de administração e dois apresentaram sinais clínicos no 24º dia; um se recuperou e outro morreu. Após finalizada esta fase do experimento e para comprovar se os caprinos que não tinham adoecido no Grupo 2 tinham também adquirido resistência, foi introduzido outro grupo com três caprinos. Esses três caprinos (Grupo 3), os cinco caprinos do Grupo 1 e os três sobreviventes do Grupo 2, ingeriram uma dose diária de 0,06g/kg. Os três caprinos do Grupo 3 adoeceram no terceiro dia após o início da ingestão, dois morreram em forma hiperaguda e o outro recuperou-se após 10 dias. Todos os caprinos dos Grupos 1 e 2 ingeriram P. aeneofusca na dose de 0,06g/kg/dia durante nove dias sem apresentar nenhum sinal clínico. Os resultados deste trabalho demonstram que a administração de doses não tóxicas repetidas de P. aeneofusca aumentam significativamente á resistência à intoxicação e que esta técnica poderia ser utilizada para o controle da intoxicação por P. aeneofusca e outras espécies de Palicourea com similar toxicidade. Os resultados de pesquisas anteriormente realizados sugerem que a resistência à intoxicação por plantas que contêm MFA é devida a proliferação de bactérias que degradam MFA no rúmen.
Palicourea aeneofusca (Müll. Arg.) Standl. is a toxic plant which contains sodium monofluoroacetate (MFA). With the objective to investigate if repeated non-toxic doses of P. aeneofusca induce resistance to the intoxication by this plant, 12 goats were distributed in two similar groups. In Group 1, resistance was induced by the administration of the dry plant, during four alternate periods: 0.02g/kg during 5 days, 0.02g/kg during 5 days, 0.03g/kg during 5 days, and 0.03g/kg during 5 days. Between the first and second period of administration and between the second and the third period, the goats did not ingest P. aeneofusca for 10 days. Between the third and the fourth administration period the goats did not ingest the plant during 15 days. One goat died suddenly during the third administration period when was ingesting 0.03g/kg. The goats from Group 2 were not adapted to the consumption of P. aeneofusca. Fifteen days after the end of the adaptation period in Group 1, both groups ingested dry P. aeneofusca in the daily dose of 0.03g/kg during 19 days. From day 20 the daily dose was increased to 0.04g/kg, which was ingested for 12 days. The goats that showed clinical signs were removed from the experiment immediately after the observation of first signs. One goat from Group 2 showed clinical signs of poisoning and died on the 12th day of ingestion, and two showed clinical signs on day 24th; one recovered and the other died. At the end of the 31 days administration period, a new group (Group 3) with three goats was introduced in the experiment to investigate if the goats that did not become poisoned in Group 2 had acquired resistance. The three goats from Group 1, five goats from Group 1, and three from Group 2 started to ingest a daily dose of 0.06g/kg of dry P. aeneofusca. On the third day of ingestion the three goats from Group 3 showed clinical signs. Two died suddenly and another recovered 10 days after the end of ingestion. All goats of Groups 1 and 2 ingested 0.06g/kg/day during nine days without showing clinical signs. These results demonstrated that non-toxic repeated doses of P. aeneofusca increase significantly the resistance to the poisoning, and that this technique possibly could be used to control the poisoning by P. aeneofusca or other toxic Palicourea species. The results of previous research work suggest that resistance is due to the proliferation of MFA degrading bacteria in the rumen.
Subject(s)
Animals , R Factors/toxicity , Plant Poisoning/veterinary , Diagnostic Techniques and Procedures/veterinary , Rubiaceae/toxicityABSTRACT
La Insuficiencia Cardíaca (IC) aguda sigue representando un importante motivo de consulta en los servicios de urgencias y de hospitalización en las unidades críticas, ocasionando elevadas tasas de mortalidad y rehospitalizaciones. Sin embargo, a diferencia de la IC crónica, donde se han producido avances significativos en la terapia médica, la evidencia y los progresos en IC aguda han sido más bien escasos. A pesar de ello existen áreas en las que se han producido logros. Se ha definido con mayor precisión el concepto de IC aguda. Los registros han entregado información relevante y se ha caracterizado de mejor forma la población de pacientes que son hospitalizados por IC. Del análisis de ellos se han propuesto algoritmos de estratificación de riesgo de fácil aplicabilidad. Han surgido conceptos fisiopatológicos nuevos, como el síndrome cardiorenal, la viabilidad miocárdica y la IC con FE preservada. Adicionalmente han aparecido biomarcadores para ayudaren el diagnóstico de IC en los servicios de urgencia y en la estratificación de riesgo de esta población en diferentes escenarios de la hospitalización para predecir mortalidad y rehospitalizaciones. Como se ha señalado, lamentablemente hemos observado pocos avances en el tratamiento farmacológico que se hayan asentado en la práctica clínica. Las principales novedades vienen de los dispositivos. Se han introducido dispositivos de ultrafiltración que podrían constituir una opción alternativa a los diuréticos en casos de congestión refractaria y lo más importante, los dispositivos de asistencia ventricular (DAV) que permiten estabilizar pacientes hacia una recuperación de la función ventricular o estabilizar la función de órganos como un puente al trasplante cardíaco.
The acute cardiac insufficiency (CI) continues to represent an important motive of consultation in the services of urgencies and of hospitalization in the critical units, causing a high rate of mortality and rehospitalization. Nevertheless, unlike the chronic cardiac insufficiency, where significant advances have been produced in the medical therapy, the evidence and the progresses acute CI have been rather scanty. In spite of it areas exist in those who have produced achievements to them. There has been defined by major precision the concept of acute CI. The records have delivered relevant information and there have been characterized of better form the population of patients who are hospitalized by CI. Of the analysis of them they have proposed algorithms of stratification of risk of easy applicability. New pathophysiological concepts have emerged as cardiorenal syndrome, myocardial viability and CI with preserved ejection fraction. Additionally biomarkers have appeared to aid in the diagnosis of cardiac insufficiency in the emergency services and risk stratification of this population in different scenarios to predict mortality and hospital readmissions. Unfortunately, we have been few advances in drug therapy have been established in clinical practice. The principal innovations come from the devices. There have interfered devices of ultrafiltration that might constitute an alternative option to the diuretics in cases of refractory congestion and the most important thing, the ventricular assist devices that patients allow to stabilize towards a recovery of the ventricular function or stabilizing the function of organs as a bridge to the cardiac transplant.