Children with malignancies and septic shock - an attempt to understand the risk factors

Abstract Objectives: To explain the high mortality of septic shock in children with cancer. Methods: A retrospective cohort from 2016 to 2020, of children aged 0 to 18 years, and septic shock. Results: The authors included 139 patients. Acute lymphocytic leukemia was the most frequent diagnosis (16.5%), and Gram-negative bacteria were the most frequent blood culture isolates (22.3%). There were 57 deaths in ICU (41%), 10 in the first 24 hours of shock (early death). A LASSO model with variables: neutropenia (coefficient 0.215), respiratory (0.81), hematological (1.41), and neurological (0.72) dysfunctions, age (-0.002) and solid tumor recurrence (0.34) generated AUC = 0.79 for the early death outcome. Survivors had significant differences in the PRISM-IV score (mean ± SD 10.9 ± 6.2 in the survivors, 14.1 ± 6.5 in the deceased, p = 0.004), and in the mean number of organ dysfunctions (3.2 ± 1.1 in the survivors, 3.8 ± 6.5 in the deceased, p < 0.001). A positive fluid balance in the first 24 hours of sepsis between 2% and 6% of body weight showed a reduction effect on the probability of death in ICU (hazard ratio 0.47, 95% CI 0.24-0.92, p = 0.027). The recurrence of any cancer was a predictor of in-hospital death, regardless of severity. Conclusions: Recurrence of any cancer is an important risk of sepsis-related death. A positive fluid balance between 20 and 60 mL/kg or 2% and 6% of body weight in the first 24 hours after the onset of sepsis is related to lower mortality.

Administración de fluidos a pacientes graves y su relación con la mortalidad / Fluids administration to seriously ill patients and its relationship with mortality

Introducción: La administración de fluidos constituye uno de los pilares de tratamiento en pacientes que ingresan en Unidades de Cuidados Intensivos, en quienes la reanimación inadecuada y la sobrecarga de volumen empeoran el pronóstico. Objetivo: Caracterizar el estado de la administración de fluidos a pacientes ingresados en la Unidad de Cuidados Intensivos del Hospital General Docente Dr. Antonio Luaces Iraola de Ciego de Ávila y su relación con la mortalidad. Métodos: Se realizó un estudio descriptivo analítico y prospectivo de 147 pacientes ingresados en la Unidad de Cuidados Intensivos del Hospital General Docente Dr. Antonio Luaces Iraola de Ciego de Ávila durante el primer semestre de 2020, para lo cual se evaluaron 598 pruebas de fluidos, algunas variables hemodinámicas y el balance de líquidos en las primeras 72 horas del ingreso. Resultados: El promedio de edad fue de 48,3 años, predominaron las mujeres (55,8 %), la puntuación de APACHE II al ingreso resultó ser de 14,2 puntos y fallecieron 22,4 % de los afectados. Para administrar fluidos prevaleció el criterio clínico (57,2%); mientras que la presión venosa central, la frecuencia cardíaca, la presión arterial media y la diuresis fueron similares en vivos y fallecidos. El balance acumulado de fluidos fue significativamente superior en el grupo de pacientes fallecidos (1984,70 mL vs 260mL). Conclusiones: Los cambios en los parámetros vitales después de administrar fluidos no fueron útiles para evaluar la respuesta al volumen. El balance acumulado de fluidos se relacionó de forma significativa con la mortalidad.

Introduction: Fluids administration constitutes one of the treatment pillars in patients admitted to Intensive Care Unit in which the inadequate reanimation and overload of volume worsen the prognosis. Objective: To characterize the state of fluid administration to patients admitted to the Intensive Cares Units of Dr. Antonio Luaces Iraola Teaching General Hospital in Ciego de Ávila and its relationship with mortality. Methods: An analytic and prospective descriptive study of 147 patients admitted to the Intensive Cares Units of Dr. Antonio Luaces Iraola Teaching General Hospital was carried out in Ciego de Ávila during the first semester of 2020, for which 598 tests of fluids, some hemodynamic variables and the balance of liquids were evaluated in the first 72 hours of admission. Results: The average age was 48.3 years, there was a prevalence of women (55.8 %), the punctuation of APACHE II at admission was 14.2 points and 22.4 % of those affected died. To administer fluids the clinical approach prevailed (57.2 %); while the central venous pressure, heart frequency, the mean arterial pressure and diuresis were similar in alive and dead patients. The accumulated balance of fluids was significantly higher in the group of dead patients (1984.70 mL vs 260 mL). Conclusions: The changes in the vital parameters after administering fluids were not useful to evaluate the response to the volume. The accumulated balance of fluids was related to mortality in a significant way.

Descongestión durante la Insuficiencia Cardíaca Aguda: importancia y monitorización / Monitoring decongestion in acute heart failure

Persistent congestion following an episode of acute heart failure is associated with higher morbidity and mortality. Monitoring diuretic therapy is essential to guide effective decongestion before patient discharge. Unfortunately, there are no markers which can predict on their own, the exact point in which euvolemia is achieved. Cardiothoracic and extra thoracic ultrasound are other tools to consider when evaluating hemodynamic and interstitial components of congestion. However, the question of which and how many parameters must be used for this purpose, is still unanswered.

Effects of massive blood transfusion on serum electrolyte balance and inflammatory factor levels in patients with severe trauma / 中国基层医药

Objective:To investigate the effects of massive blood transfusion on serum electrolyte balance and serum levels of C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in patients with severe trauma.Methods:A total of 83 patients with severe trauma who received treatment in Eastern District of LiHuili Hospital, Ningbo Medical Center between July 2019 and December 2020 were included in this study. All of them underwent blood transfusion. They were divided into massive blood transfusion group ( n = 29) and general blood transfusion group ( n = 54) according to the volume of blood transfused. Changes in coagulation function, electrolyte, liver-kidney function and inflammatory factor levels pre- and post-blood transfusion were compared between massive blood transfusion and general blood transfusion groups. Results:At 1 day after blood transfusion, activated partial thromboplastin time (APTT) and prothrombin time (PT) in the massive blood transfusion group were (45.64 ± 2.78) seconds and (17.71 ± 2.08) seconds, respectively, which were significantly longer than those in the general blood transfusion group [(41.02 ± 2.80) seconds, (15.35 ± 1.72) seconds, t = 5.53, 7.18, P < 0.05). At 1 day after blood transfusion, levels of tumor necrosis factor-α, interleukin-6 and C-reaction protein in the massive blood transfusion group were (1.84 ± 0.32) μg/L, (113.72 ± 13.34) ng/L, (28.94 ± 4.22) mg/L, respectively, which were significantly increased compared with those measured before blood transfusion [(1.28 ± 0.29) μg/L, (95.18 ± 10.64) ng/L, (16.48 ± 3.37) mg/L, t = 6.98, 5.85, 12.42, all P < 0.05]. Levels of tumor necrosis factor-α, interleukin-6 and C-reaction protein in the general blood transfusion group were (1.34 ± 0.27) μg/L, (98.54 ± 9.62) ng/L, (20.05 ± 3.30) mg/L, respectively at 1 day after blood transfusion, which were significantly increased compared with those measured before blood transfusion [(1.23 ± 0.26) μg/L, (94.22 ± 8.82) ng/L, (16.16 ± 3.39) mg/L, t = 2.15, 2.43, 6.04, all P < 0.05]. At 1 day after blood transfusion, serum levels of tumor necrosis factor-α and C-reaction protein in the massive blood transfusion group were significantly higher than those in the general blood transfusion group ( t = 7.53, 10.59, both P < 0.05). At 1 day after blood transfusion, serum levels of K + and Ca 2+ in the massive blood transfusion group were (3.56 ± 0.54) mmol/L and (1.87 ± 0.28) mmol/L, respectively, which were significantly lower than those in the general blood transfusion group [(4.27 ± 0.34) mmol/L, (2.26 ± 0.24) mmol/L, t = 7.34, 6.65, both P < 0.05]. Serum levels of alanine aminotransferase and aspartate aminotransferase in the massive blood transfusion group were (52.46 ± 20.27) U/L, (82.37 ± 31.15) U/L, respectively, which were significantly higher than those in the general blood transfusion group [(37.57 ± 10.31) U/L, (49.35 ± 10.14) U/L, t = 4.44, 7.14, both P < 0.05)]. The incidence of abnormal liver function in the massive blood transfusion group was significantly higher than that in the general blood transfusion group [62.07% (18/29) vs. 29.63% (16/54), χ2 = 10.13, P < 0.05)]. Conclusion:The internal environment of patients with severe trauma will change after massive blood transfusion. Their coagulation function, inflammatory factors, liver function and electrolyte balance should be monitored in time.

O balanço hídrico pós-extubação se associa com falha da extubação: um estudo de coorte / Postextubation fluid balance is associated with extubation failure: a cohort study

RESUMO Objetivo: Avaliar se há associação entre o balanço hídrico nas 48 horas após a extubação e a falha da extubação. Métodos: Este é um estudo de coorte prospectiva que incluiu os pacientes admitidos à unidade de terapia intensiva de um hospital terciário no sul do Brasil entre março e dezembro de 2019. Incluíram-se os pacientes que necessitaram de ventilação mecânica por pelo menos 24 horas e foram extubados durante o período do estudo. O desfecho primário foi falha da extubação, considerada como necessidade de reintubar dentro das primeiras 72 horas após a extubação. O desfecho secundário foi um desfecho combinado de falha da extubação ou necessidade de ventilação não invasiva terapêutica. Resultados: Foram incluídos 101 pacientes. Observou-se falha da extubação em 29 (28,7%) deles. Na análise univariada, pacientes com balanço hídrico negativo acima de 1L no período de 48 horas após a extubação tiveram menor taxa de falha da extubação (12,0%), em comparação a pacientes com balanço hídrico negativo nas 48 horas após a extubação menor que 1L (34,2%; p = 0,033). A duração da ventilação mecânica e o balanço hídrico negativo nas 48 horas após a extubação inferior a 1L se associaram com falha da extubação na análise multivariada quando corrigido pelo Simplified Acute Physiology Score 3. Quando avaliou-se o desfecho combinado, apenas o balanço hídrico nas 48 horas pós-extubação inferior a 1L manteve associação, quando corrigido pelo Simplified Acute Physiology Score 3 e duração da ventilação mecânica. Conclusão: O balanço hídrico nas 48 horas após a extubação se associa com falha da extubação. São necessários mais estudos para avaliar se evitar um balanço hídrico positivo nesse período poderia melhorar os desfechos do desmame.

ABSTRACT Objective: To assess whether there is an association between 48-hour postextubation fluid balance and extubation failure. Methods: This was a prospective cohort study that included patients admitted to the intensive care unit of a tertiary hospital in southern Brazil from March 2019 to December 2019. Patients who required mechanical ventilation for at least 24 hours and who were extubated during the study period were included. The primary outcome was extubation failure, considered as the need for reintubation in the first 72 hours after extubation. The secondary outcome was a combined outcome with extubation failure or the need for therapeutic noninvasive ventilation. Results: A total of 101 patients were included. Extubation failure was observed in 29 (28.7%) patients. In univariate analysis, patients with a negative 48-hour postextubation fluid balance higher than one liter had a lower rate of extubation failure (12.0%) than patients with a negative 48-hour postextubation fluid balance lower than 1L (34.2%; p = 0.033). Mechanical ventilation duration and negative 48-hour postextubation fluid balance lower than one liter were associated with extubation failure when corrected for Simplified Acute Physiology Score 3 in multivariate analysis. When we evaluated the combined outcome, only negative 48-hour postextubation lower than 1L maintained an association when corrected for for Simplified Acute Physiology Score 3 and mechanical ventilation duration. Conclusion: The 48-hour postextubation fluid balance is associated with extubation failure. Further studies are necessary to assess whether avoiding positive fluid balance in this period might improve weaning outcomes.

Balanço hídrico em unidade de terapia intensiva / Balance hídrico en una unidad de cuidados intensivos / Water balance in an intensive care unit

Objetivo: Discorrer e analisar o preenchimento dos impressos de balanço hídrico de pacientes internados em uma Unidade de Terapia Intensiva pela equipe de enfermagem. Método: Estudo transversal, realizado de fevereiro a dezembro de 2016. Amostra aleatória simples, composta de 220 impressos de balanço hídrico, aprovado no Comitê de Ética em Pesquisa, Protocolo nº. 2.494.058. Análise por meio do SPSS Statistics 22.0 (IBM), utilizando-se estatística descritiva, cálculo de distribuição de frequência, medidas de tendência central e de dispersão. Resultados: 92,7% dos balanços hídricos foram concluídos. Deste total, 54,5% apresentaram erros de cálculos; 37,30%, uso de caneta imprópria; 53,20%, letra ilegível; 84,1%, rasuras; 78,6% erros de registro de dados; 50,50%, anotações inadequadas em colunas. Há 40,7% de chances de um balanço hídrico correto se não houver falhas nos registros e o mesmo for concluído. Conclusão: Os resultados evidenciam a necessidade de capacitação da equipe de enfermagem e de revisão do protocolo assistencial.(AU)

Objective: To discuss and analyze the filling out of fluid balance forms for patients admitted to an Intensive Care Unit by the nursing team. Method: A cross-sectional study, conducted from February to December 2016. A simple random sample, composed of 220 water balance forms, approved by the Research Ethics Committee, Protocol No. 2.494.058. Analysis using SPSS Statistics 22.0 (IBM), using descriptive statistics, calculation of frequency distribution, measures of central tendency and dispersion. Results: A total of 92.7% of the hydric balances were completed. Of this total, 54.5% presented calculation errors; 37.30%, use of improper pen; 53.20%, illegible handwriting; 84.1%, erasures; 78.6% data registration errors; 50.50%, inadequate annotations in columns. There is a 40.7% chance of a correct water balance if there are no flaws in the records and it is completed. Conclusion: The results show the need for training of the nursing team and revision of the care protocol(AU)

Objetivo: Describir y analizar el balance hídrico realizado por el personal de enfermería en una Unidad de Cuidados Intensivos. Método: Estudio transversal, celebrada de febrero a diciembre de 2016. Muestra aleatoria simple, compuesta por 220 balances hídricos, aprobada por el Comité de Ética en Investigación, Protocolo nº. 2.494.058. Análisis a través del SPSS Statistics 22.0 (IBM), utilizando estadística descriptiva, cálculo de distribución de frecuencias, medidas de tendencia central y dispersión. Resultados: 92,7% de los balances hídricos. De este total, el 54,5% tuvo errores de cálculo; 37,30%, utilizando un bolígrafo inadecuado; 53,20%, caligrafía ilegible; 84,1%, tachaduras; 78,6% de errores de entrada de datos; 50,50%, anotaciones de columna inapropiadas. Hay un 40,7% de probabilidad de un correcto balance hídrico si no hay errores en los registros y se completa el mismo. Conclusión: Los resultados muestran la necesidad de capacitar al personal de enfermería y revisar el protocolo de atención.(AU)

Fluid and hemodynamic management in hemodialysis patients: challenges and opportunities / Manejo hídrico e hemodinâmico em pacientes em hemodiálise: desafios e oportunidades

Abstract Fluid volume and hemodynamic management in hemodialysis patients is an essential component of dialysis adequacy. Restoring salt and water homeostasis in hemodialysis patients has been a permanent quest by nephrologists summarized by the 'dry weight' probing approach. Although this clinical approach has been associated with benefits on cardiovascular outcome, it is now challenged by recent studies showing that intensity or aggressiveness to remove fluid during intermittent dialysis is associated with cardiovascular stress and potential organ damage. A more precise approach is required to improve cardiovascular outcome in this high-risk population. Fluid status assessment and monitoring rely on four components: clinical assessment, non-invasive instrumental tools (e.g., US, bioimpedance, blood volume monitoring), cardiac biomarkers (e.g. natriuretic peptides), and algorithm and sodium modeling to estimate mass transfer. Optimal management of fluid and sodium imbalance in dialysis patients consist in adjusting salt and fluid removal by dialysis (ultrafiltration, dialysate sodium) and by restricting salt intake and fluid gain between dialysis sessions. Modern technology using biosensors and feedback control tools embarked on dialysis machine, with sophisticated analytics will provide direct handling of sodium and water in a more precise and personalized way. It is envisaged in the near future that these tools will support physician decision making with high potential of improving cardiovascular outcome.

Resumo O volume de fluidos e o controle hemodinâmico em pacientes em hemodiálise é um componente essencial da adequação da diálise. A restauração da homeostase do sal e da água em pacientes em hemodiálise tem sido uma busca constante por parte dos nefrologistas, no que condiz à abordagem do "peso seco. Embora essa abordagem clínica tenha sido associada a benefícios no desfecho cardiovascular, recentemente tem sido questionada por estudos que mostram que a intensidade ou agressividade para remover fluidos durante a diálise intermitente está associada a estresse cardiovascular e dano potencial a órgãos.para remover fluidos durante a diálise intermitente está associada a estresse cardiovascular e dano potencial a órgãos. Uma abordagem mais precisa é necessária para melhorar o desfecho cardiovascular nessa população de alto risco. A avaliação e monitorização do estado hídrico baseiam-se em quatro componentes: avaliação clínica, ferramentas instrumentais não invasivas (por exemplo, US, bioimpedância, monitorização do volume sanguíneo), biomarcadores cardíacos (e.g. peptídeos natriuréticos), algoritmos e modelagem de sódio para estimar a transferência de massa. O manejo otimizado do desequilíbrio hídrico e de sódio em pacientes dialíticos consiste em ajustar a remoção de sal e líquido por diálise (ultrafiltração, dialisato de sódio), e restringir a ingestão de sal e o ganho de líquido entre as sessões de diálise. Tecnologia moderna que utiliza biosensores e ferramentas de controle de feedback, hoje parte da máquina de diálise, com análises sofisticadas, proporcionam o manejo direto sobre o sódio e a água de uma maneira mais precisa e personalizada. Prevê-se no futuro próximo que essas ferramentas poderão auxiliar na tomada de decisão do médico, com alto potencial para melhorar o resultado cardiovascular.

Relación entre sobrecarga hídrica y mortalidad en niños conshock séptico / Relation between fluid overload and mortality in children with septic shock

El shock séptico es una de las principales causas que puede llevar a la muerte. La reanimación hídrica constituye un destacado tratamiento para poder disminuir la mortalidad. Objetivo: determinar la relación entre el porcentaje de sobrecarga hídrica (%SH) y la mortalidad en niños con shock séptico. Métodos. Estudio de cohorte en pacientes con shock séptico de entre 1 y 17 años, posterior a la reanimación hídrica con presión venosa central ≥ 5 mmHg con monitoreo invasivo y registro completo de %SH hasta las 96 h. El seguimiento y la variable de desenlace se completaron hasta el día 28. Se registraron las siguientes variables del shock séptico, shock refractario, causa de la insuficiencia renal aguda, anemia, desnutrición, el tiempo de inicio de antimicrobiano, presión oncótica y puntaje de gravedad. Análisis estadístico: Se calculó el hazard ratio (HR) y se construyeron tres modelos pronósticos por riesgos proporcionales de Cox. Resultados. La población fue de 263 pacientes; con un promedio de edad de 8 ± 3 años y con mortalidad del 33 %. El %SH ≥ 10,1 acumulado a las 96 h fue el único asociado; el HR (IC 95 %) ajustado fue perfil hemodinámico HR = 2,6 (1,95,6); por shock refractario, HR = 2,5 (1,6-5,6) y por desnutrición, HR = 8,3 (3,5-14). Conclusiones. El %SH > 10,1 % se relacionó con una mayor mortalidad a 28 días de ajustado al perfil hemodinámico, la refractariedad del shock y el estado nutricional.

Septic shock is one of the main causes of mortality. Fluid replacement stands out as the treatment of choice to reduce mortality. Objective. To determine the relation between the percentage of fluid overload (%FO) and mortality in children with septic shock. Methods. Cohort study in patients aged 1-17 years with septic shock, after fluid replacement with central venous pressure ≥ 5 mmHg, invasive monitoring, and complete recording of %FO up to 96 h. Follow-up and outcome measures were recorded up to day 28. The following outcome measures of septic shock were recorded: refractory shock, cause of acute kidney injury, anemia, malnutrition, time to antibiotic initiation, oncotic pressure, and severity score. Statistical analysis. The hazard ratio (HR) was estimated and three Cox proportional hazard models were developed. Results. The population included 263 patients; their average age was 8 ± 3 years. Mortality was 33 %. A %FO ≥ 10.1 % accumulated at 96 h was the only associated outcome measure; the HR (95 % confidence interval) was adjusted for hemodynamic profile, HR = 2.6 (1.95.6); refractory shock, HR = 2.5 (1.6-5.6); and malnutrition, HR = 8.3 (3.5-14). Conclusions. A %FO > 10.1 % was related to a higher mortality at 28 days of adjustment for hemodynamic profile, refractory shock, and nutritional status.

Treatment experience of large area cerebral infarction with portal vein pneumatosis / 中国中西医结合急救杂志

Acute cerebral infarction possesses the characteristics of high incidence, high disability rate and high mortality, especially in patients with large area cerebral infarction accompanied by a variety of chronic diseases,such as systemic hypertension, hyperglycemia, obesity, etc risk factors, their mortality will be much higher. Simultaneously, in the treatment of large area cerebral infarction, special attention should be paid on monitoring the disease situation changes of patients' electrolyte balance, digestive system and other systems; in this study, the experiences of treating a patient with large area cerebral infarction and occurrence of serious complications as portal vein pneumatosis, intestinal obstruction, etc in the course of disease were summarized.

CIRCULAÇÃO EXTRACORPÓREA E DESIQUILÍBRIO HIDROELETROLÍTICO / EXTRACORPOREAL CIRCULATION AND HYDROELECTROLYTIC IMBALANCE / CIRCULACIÓN EXTRACORPÓREA Y DESEQUILIBRIO ELECTROLÍTICO

Objetivo: realçar aspectos da circulação extracorpórea relacionado ao desiquilíbrio hidroeletrolítico. Métodos: trata-se de um ensaio teórico-reflexivo, embasado em um levantamento dos artigos científicos disponíveis na Scielo, Lilacs e Medline entre os anos de 2004 e 2014 enfocando a temática da circulação extracorpórea. Resultados: as alterações hidroeletrolíticas, podem significar riscos iminentes ao paciente cardíaco cirurgicamente assistido, de modo que ao ser submetido ao procedimento, o indivíduo deve estar com suas funções sistêmicas equilibradas ou, do contrário, ao se identificar as respectivas alterações, os órgãos artificiais devem realizar a adequação das falhas e estabilizar o que estiver inadequado à preservação da vida humana. Porém um dos desafios é dispor de uma equipe e recursos suficientes para essa assistência e suporte diante de intercorrências. Conclusão: verifica-se que os pacientes submetidos a CEC ficam sujeitos a sofrer com efeitos colaterais que levam a um efetivo desequilíbrio hidroeletrolítico, sendo essencial que haja um monitoramento contínuo de seu estado, no período intra e pós operatório.

Objective: highlight aspects of extracorporeal circulation related to hydroelectrolytic imbalance. Method: this is a theoretical-reflexive essay, based on a survey of the scientific articles available in Scielo, Lilacs and Medline between the years 2004 and 2014 focusing on the subject of extracorporeal circulation. Results: hydroelectrolytic alterations can pose imminent risks to the surgically assisted cardiac patient, so that when subjected to the procedure, the individual must have his or her balanced systemic functions or, in the opposite, in identifying the respective alterations, the artificial organs must perform the Adequacy of failures and stabilize what is unsuitable for the preservation of human life. However, one of the challenges is to have sufficient staff and resources for this assistance and support in the event of an incident. Conclusion: it is verified that patients undergoing CPB are subject to suffer from side effects that lead to an effective hydroelectrolytic imbalance, and it is essential that there be a continuous monitoring of their state, intra and postoperative period.

Objetivo: resaltar los aspectos de la circulación extracorpórea relacionados con el desequilibrio de líquidos y electrolitos. Método: este es un ensayo teórico y reflexivo, basado en una encuesta de artículos científicos disponibles en Scielo, Lilacs y Medline entre los años 2004 y 2014 se centra en el tema de la circulación extracorpórea. Resultados: los cambios electrolíticos podría significar riesgos inminentes para la paciente cardíaco asistido quirúrgicamente, por lo que al someterse al procedimiento, el individuo debe estar con sus funciones de sistema equilibrado o de otro modo, para identificar cualquier modificación de los órganos artificiales debe llevar a cabo adecuación de los fracasos y estabilizar los que no son adecuadas para la preservación de la vida humana. Pero uno de los retos es tener un equipo y los recursos suficientes para tal asistencia y apoyo antes de complicaciones. Conclusión: se ha encontrado que los pacientes sometidos a la CEC están sujetos a sufrir de efectos secundarios que conducen a un desequilibrio electrolítico eficaz, es esencial que haya un seguimiento continuo de su estado, en el período intra y postoperatorio.

Efeito vascular e central do carvacrol na hipertensão e na inibição do apetite por sódio em ratos / Vascular and central effects of carvacrol on hypertension and inhibition of sodium appetite in rats

INTRODUÇÃO: A hipertensão arterial tem sido considerada como sendo a principal causa da redução da qualidade e expectativa de vida dos indivíduos por ser importante fator de risco para doenças que envolvem a aterosclerose e a trombose com consequente acometimento cardíaco, cerebral, renal e vascular. Estudos têm demonstrado a ação dos monoterpenos em diferentes atividades farmacológicas, entre elas sobre o sistema cardiovascular. Foi observado que o carvacrol, um monoterpeno característico da família Labiateae, apresenta ação hipotensora em ratos Wistar anestesiados tratados previamente com L-NAME e em ratos não anestesiados. OBJETIVOS: a) avaliar a ação periférica do carvacrol na pressão arterial e na frequência cardíaca em animais com hipertensão arterial vascular; b) avaliar a ação periférica do carvacrol na pressão arterial e na frequência cardíaca em ratos com hipertensão renovascular; c) avaliar a ação periférica do carvacrol sobre a pressão arterial e a frequência cardíaca em ratos espontaneamente hipertensos; d) avaliar a ação central do carvacrol sobre a pressão arterial e a frequência cardíaca em animais espontaneamente hipertensos; e) avaliar a ação central do carvacrol no apetite por sódio em animais espontaneamente hipertensos. MATERIAL E MÉTODOS: Foram utilizados ratos Wistar (200-250g)...

INTRODUCTION: Hypertension has been regarded as the primary cause of the reduction of the quality and life expectancy of individuals for being important factor ate risk for diseases that involve the atherosclerosis and thrombosis with consequent cardiac involvement, cerebral, renal and vascular. Studies have demonstrated the action of monoterpenes in different pharmacological activities, among them on the cardiovascular system. It was observed that the carvacrol, a characteristic of the monoterpene Labiateae family, presents hypotensive action in anesthetized Wistar rats pretreated with L-NAME and not anesthetized rats. AIM: a) evaluate the peripheral action of carvacrol on blood pressure and heart rate in animals with vascular arterial hypertension; b) evaluate the peripheral action of carvacrol on blood pressure and heart rate in rats with renovascular hypertension; c) evaluate the peripheral action of carvacrol on blood pressure and heart rate in animals spontaneously hypertensive; d) evaluate the central action of carvacrol on blood pressure and heart rate in animals spontaneously hypertensive; e) evaluate the action of carvacrol in central appetite for sodium in spontaneosuly hypertensive. MATERIALS AND METHODS: Were used Wistar rats (200-250g)...

Analysis on diuretic effect of a phenylphthalazines compound PU1424 / 中国药理学通报

Aim To study on the diuretic effect of a phenylphthalazines compound PU1424 and its influence on electrolyte balance, glucose and lipid metabolism, hepatic and renal functions.Methods Male Sprague Dawley rats were randomly divided into solvent control group,PU1424 treated group and HCTZ treated group.Urine was collected per 6 h and blood samples were collected at the end of drug administration.Urinary osmolality was measured by Freezing Point Osmometer;urea concentration was measured by Urea Detection Kit;ion level, blood glucose level, blood lipid level, hepatic and renal function were analyzed by Automatic Biochemical Analyzer.Results Compared to the solvent control group, and urine output of rats treated with PU1424 and HCTZ was increased as 1.52 times and 1.78 times and water intake increased as 1.42 times and 1.56 times respectively.Urine osmolalities were decreased as 61.5% and 50.4% of the control group, and urine urea concentration was decreased as 57.1% and 56.8% of the control group.Urinary electrolytes were decreased by administration of PU1424 and HCTZ compared to the intact plasma electrolytes.The blood glucose levels and blood lipid levels of rats treated with PU1424 had no changes, while the blood glucose and total cholesterol were increased by administration of HCTZ.The urea nitrogen, creatinine, alkaline phosphatase and total protein were intact by administration of PU1424 and HCTZ except the alanine/straw ration increased by HCTZ.Conclusion New diuretic candidate compound PU1424 displays significant diuretic effect with electrolyte balance, blood glucose level, blood lipid level, hepatic and renal function intact.

Ronda clínica y epidemiológica: club de revistas / Clinical and epidemiological round: journal club / Ronda clínica e epidemiológica: clube de revistas

En esta nueva edición de la Ronda Clínica y Epidemiológica analizamos cuatro estudios que consideramos importantes para la práctica clínica. El estudio SOME, en el cual Carrier y colaboradores evaluaron la eficacia de la tamización para el cáncer oculto en pacientes con primer episodio no provocado de tromboembolia venosa. El estudio de Freedman y colaboradores muestra que el uso de jugo de manzanas y líquidos elegidos libremente no es inferior a las soluciones hidroelectrolíticas en la terapia de rehidratación oral en pacientes pediátricos con gastroenteritis aguda de bajo riesgo. Gágyor y colaboradores investigaron sobre el uso de ibuprofeno comparado con el de fosfomicina en el tratamiento sintomático de las infecciones urinarias no complicadas. Finalmente, el metaanálisis de Martindale y colaboradores consolida una información valiosa respecto a las pruebas que se deben hacer en el diagnóstico de falla cardíaca aguda.

In this new edition of Ronda Clínica y Epidemiológica, four studies that we consider important for clinical practice are analyzed. The SOME study, in which Carrier et al., evaluated the efficacy of a screening strategy for occult cancer in patients with a first unprovoked venous thromboembolism. The study by Freedman et al., shows that the use of apple juice is not inferior to oral electrolyte maintenance solution in children with mild gastroenteritis. Gágyor et al., investigated about the use of ibuprofen versus fosfomycin for treating symptoms of uncomplicated urinary tract infection. Finally, the meta-analysis of Martindale et al., provided valuable information about the tests that should be done in the diagnosis of acute heart failure.

Nesta nova edição da Ronda Clínica e Epidemiológica analisamos quatro estudos que consideramos importantes para a prática clínica. O estudo SOME, no qual Carrier e colaboradores avaliaram a eficácia da tamisação para o câncer oculto em pacientes com primeiro episódio não provocado de tromboembolia venosa. O estudo de Freedman e colaboradores mostra que o uso de suco de maçãs e líquidos elegidos livremente não é inferior às soluções hidroeletrolíticas na terapia de reidratação oral em pacientes pediátricos com gastroenterite aguda de baixo risco. Gágyor e colaboradores investigaram sobre o uso de Ibuprofeno comparado com o de Fosfomicina no tratamento sintomático das infeções urinárias não complicadas. Finalmente, a meta-análise de Martindale e colaboradores consolida uma informação valiosa com respeito às provas que se deve fazer no diagnóstico de falha cardíaca aguda.

Efeito alcalinizante da solução de Ringer com lactato em ovelhas sadias e acidóticas / Alkalinizing effect of lactated Ringer's solution in healthy and acidotic sheep

O estudo teve o objetivo de testar a hipótese de que o efeito alcalinizante da solução de Ringer com lactato (SRL) pode ser maior nos animais portadores de acidose metabólica do que nos sadios, como consequência da necessidade de retorno ao equilíbrio. Seis ovelhas receberam a SRL em volume correspondente a 10% do peso corporal, administrada por infusão contínua intravenosa, durante quatro horas, em duas condições definidas: enquanto eram saudáveis e após a indução experimental de acidose láctica ruminal aguda (ALRA). Amostras de sangue venoso e de urina foram colhidas em quatro momentos: antes do início da infusão, na metade do volume infundido, ao término da infusão e duas horas após. Foram determinados valores de pH sanguíneo e urinário, de pCO2, HCO3 - e BE no sangue, de Na+, K+, Cl-, SID, AG, PPT, Atot e lactato L no plasma, e das excreções fracionadas urinárias de Na+, K+, Cl- e lactato L. A SRL provocou hemodiluição, mas não interferiu nos equilíbrios eletrolítico e acidobase das ovelhas sadias. Apesar de eficaz para reverter a desidratação, não foi capaz de corrigir a acidose metabólica presente após a indução da ALRA.

The aim of this study was to investigate if the alkalinizing effect of lactated Ringer's solution (LRS) is greater in animals with metabolic acidosis than in healthy ones, as a result of the need to restore acid-base balance. LRS was intravenously infused in a volume corresponding to 10% of body weight, continously during four hours, in two definite conditions in the same six ewes: when they were healthy and after experimentally induced acute rumen lactic acidosis (ARLA). Venous blood and urine samples were taken in four moments: before the beginning, in the middle, at the end of the infusion and two hours after. Blood and urine pH, blood pCO2, HCO3 - and BE, and plasma Na+, K+, Cl-, TP and L lactate were measured. Na+, K+, Cl- and L lactate fractional clearance and plasma SID, AG, and Atot were calculated. LRS caused hemodilution but didn't change electrolyte and acid-base balances in healthy ewes. When ewes were affected by ARLA, the infusion of this solution was effective for dehydration reversion but was unable to correct metabolic acidosis.

O que ocorre com o balanço hídrico durante e após a reversão do choque séptico? / What happens to the fluid balance during and after recovering from septic shock?

Objetivo: Avaliar o balanço hídrico acumulado durante o período do choque e determinar o que ocorre com ele nos 7 dias que se seguem à reversão do choque. Métodos: Estudo prospectivo e observacional, realizado em pacientes com choque séptico. Foram incluídos pacientes com pressão arterial média ≥ 65mmHg e lactato < 2,0mEq/L desmamados há menos de 12 horas do uso de vasopressores, sendo esse dia considerado o Dia 1. O balanço hídrico diário foi registrado por 7 dias após recuperação do choque. Os pacientes foram divididos em dois grupos, segundo a mediana da coorte para o balanço hídrico acumulado durante o período do choque: Grupo 1 ≤ 4,4L (n = 20) e Grupo 2 > 4,4L (n = 20). Resultados: Inscrevemos, neste estudo, um total de 40 pacientes. No Dia 1 do estudo, o balanço hídrico acumulado era de 1,1 [0,6 - 3,4] L no Grupo 1 e 9,0 [6,7 - 13,8] L no Grupo 2. No Dia 7 do estudo, o balanço hídrico acumulado era de 8,0 [4,5 - 12,4] L no Grupo 1 e 14,7 [12,7 - 20,6] L no Grupo 2 (p < 0,001 para ambos). A seguir, após a recuperação do choque, o balanço hídrico continuou a aumentar em ambos os grupos. Em comparação ao Grupo 1, o Grupo 2 teve um tempo mais longo de permanência na unidade de terapia intensiva e no hospital. Conclusão: São frequentemente observados balanços hídricos positivos em pacientes com choque séptico, o que pode estar relacionado a desfechos piores. Durante o período do choque, mesmo que o balanço hídrico fosse previamente positivo, este se torna ainda mais positivo. Após a recuperação do choque, o balanço hídrico continua a aumentar. Esse grupo com um balanço hídrico mais positivo permaneceu por mais tempo na unidade de terapia intensiva e no hospital. .

Objective: We aimed to evaluate the cumulative fluid balance during the period of shock and determine what happens to fluid balance in the 7 days following recovery from shock. Methods: A prospective and observational study in septic shock patients. Patients with a mean arterial pressure ≥ 65mmHg and lactate < 2.0mEq/L were included < 12 hours after weaning from vasopressor, and this day was considered day 1. The daily fluid balance was registered during and for seven days after recovery from shock. Patients were divided into two groups according to the full cohort’s median cumulative fluid balance during the period of shock: Group 1 ≤ 4.4L (n = 20) and Group 2 > 4.4L (n = 20). Results: We enrolled 40 patients in the study. On study day 1, the cumulative fluid balance was 1.1 [0.6 - 3.4] L in Group 1 and 9.0 [6.7 - 13.8] L in Group 2. On study day 7, the cumulative fluid balance was 8.0 [4.5 - 12.4] L in Group 1 and 14.7 [12.7 - 20.6] L in Group 2 (p < 0.001 for both). Afterwards, recovery of shock fluid balance continued to increase in both groups. Group 2 had a more prolonged length of stay in the intensive care unit and hospital compared to Group 1. Conclusion: In conclusion, positive fluid balances are frequently seen in patients with septic shock and may be related to worse outcomes. During the shock period, even though the fluid balance was previously positive, it becomes more positive. After recovery from shock, the fluid balance continues to increase. The group with a more positive fluid balance group spent more time in the intensive care unit and hospital. .

Efeito da suplementação de cloreto de amônio sobre os equilíbrios eletrolítico e ácido-básico e o pH urinário de ovinos confinados / Effect of supplementation of ammonium chloride on electrolyte and acid-base balances and urinary pH of feedlot sheep

A incidência da urolitíase obstrutiva em ovinos é elevada, principalmente em machos confinados, tanto para produção de carne, quanto reprodutores de alto valor genético. A acidificação urinária é um dos métodos para prevenção desta enfermidade e pode ser realizada de forma eficaz com a suplementação de cloreto de amônio na dieta, que pode propiciar a instalação de acidose metabólica. A hemogasometria avalia o equilíbrio ácido-básico sanguíneo de forma prática e fácil. Neste trabalho, avaliou-se o efeito do cloreto de amônio sobre o equilíbrio ácido-básico e eletrolítico de ovinos em confinamento para quantificar a acidose metabólica desenvolvida. Utilizaram-se 100 ovinos, machos, confinados, com idade aproximada de três meses. Constituíram-se três grupos experimentais: Grupo I (n=40), recebeu 400mg/kg/PV de cloreto de amônio/animal/dia por 21 dias consecutivos, momento da interrupção da administração do acidificante urinário (M3) e continuidade do acompanhamento clinico até o final do experimento (M6); Grupo II (n=40), 400mg/kg/PV de cloreto de amônio/animal/dia por 42 dias consecutivos; Grupo III (n=20), não recebeu cloreto de amônio durante todo o período do experimento. Os Momentos (M) de colheita de amostras e avaliação clínica foram estabelecidos com intervalo de sete dias, sendo M0 (imediatamente antes do início do tratamento com cloreto de amônio), M1 (sete dias após), M2, M3, M4, M5 e M6, totalizando 56 dias de confinamento. A alimentação consistiu de ração total, composta por 15% de feno triturado e 85% de concentrado, água e sal mineral ad libitum. Após adaptação de 15 dias à dieta de confinamento, colheram-se de todos os animais amostras de urina para mensuração do pH, e sangue venoso para hemogasometria, nos diferentes momentos...

The incidence of obstructive urolithiasis in sheep is high, especially in feedlot males, both for meat production, or the breeder of high genetic value. The urinary acidification is one way to prevent this disease and can be performed effectively supplementation with ammonium chloride in the diet, which may facilitate the installation of metabolic acidosis. The blood gas analysis evaluates the acid-base balance of blood in a practical and easy way. In this study, it was evaluated the effect of ammonium chloride on acid-base and electrolyte in feedlot sheep blood gas analysis to determine the occurrence of metabolic acidosis. It was used 100 male lambs, in a feedlot, aged approximately three months. It was constituted three groups: Group I (n=40) that received 400mg/kg/PV of ammonium chloride/animal/day for 21 consecutive days, the time of discontinuation of the urinary acidifiers (M3) and continued clinical follow until the end of the experiment (M6); Group II (n=40), that received 400mg/kg/PV of ammonium chloride/animal/day for 42 consecutive days, Group III (n=20), that did not receive ammonium chloride throughout the experimental period. The moments (M) of samples and clinical assessment were established on seven days of interval, M0 (immediately before the beginning of the treatment with ammonium chloride), M1 (seven days after), M2, M3, M4, M5 and M6, totalizing 56 days of feedlot. The feed consisted of a total mixed ration consisting of 15% of ground hay and 85 % of concentrate, water and mineral salt ad libitum. After 15 days of adaptation to the diet of feedlot, urine samples for measurement of pH, and venous blood for blood gas analysis were collected from all animals at different moments. The urinary acidification was maintained as was the administration of ammonium chloride in GI and GII. The values of Na+ and K+ remained within the normal range for the species...

Regulation of aquaporin-2 in the kidney : A molecular mechanism of body-water homeostasis

The kidneys play a key role in the homeostasis of body water and electrolyte balance. Aquaporin-2 (AQP2) is the vasopressin-regulated water-channel protein expressed at the connecting tubule and collecting duct, and plays a key role in urine concentration and body-water homeostasis through short-term and long-term regulation of collecting duct water permeability. The signaling transduction pathways resulting in the AQP2 trafficking to the apical plasma membrane of the collecting duct principal cells, including AQP2 phosphorylation, RhoA phosphorylation, actin depolymerization, and calciumm obilization, and the changes of AQP2 abundance in water-balance disorders have been extensively studied. Dysregulation of AQP2 has been shown to be importantly associated with a number of clinical conditions characterized by body-water balance disturbances, including hereditary nephrogenic diabetes insipidus (NDI), lithium-induced NDI, electrolytes disturbance, acute and chronic renal failure, ureteral obstruction, nephrotic syndrome, congestive heart failure, and hepatic cirrhosis. Recent studies exploiting omics technology further demonstrated the comprehensive vasopressin signaling pathways in the collecting ducts. Taken together, these studies elucidate the underlying molecular mechanisms of body-water homeostasis and provide the basis for the treatment of body-water balance disorders.

Análise da suplementação de carboidratos e solução isotônica sobre parâmetros hematológicos e bioquímicos de jogadores profissionais de futebol em condições reais de treinamento / Analysis of carbohydrate supplementation and isotonic solution hematological and biochemical parameters on professional soccer players in real training / El análisis de los suplementos de hidratos de carbono en solución isotónica y parámetros hematológicos y bioquímicos de jugadores profesionales de fútbol en entrenamiento real

Avaliou-se o efeito de uma suplementação com carboidratos e bebidas esportivas sobre parâmetros laboratoriais em atletas de futebol de campo, em uma situação real de treinamento. Foram coletados 10 ml de sangue venoso e 50 ml de urina em repouso e 15 minutos após treinamento. Os resultados mostram que o exercício intenso causou um variável grau de estase urinária, bem como provocou alterações hidroeletrolíticas caracterizadas por uma diminuição na concentração sérica de sódio, potássio, magnésio, fósforo e glicose (p<0,05), que não foi modificada por nenhum tipo de protocolo de suplementação nas condições propostas no presente estudo. A suplementação eletrolítica proposta mostrou-se limitada para evitar variações eletrolíticas e que a reposição deve ser avaliada à luz de um contexto ambiental e de treinamento.

The aim of this study was evaluate the effect of supplementation with carbohydrate sports drinks and laboratory parameters in athletes on the football field, in a real training. 10 ml of venous blood and 50 ml of urine were collected at rest and 15 minutes after training. The results show that intense exercise caused a variable degree of urinary stasis and electrolyte changes caused by a marked decrease in serum sodium, potassium, magnesium, phosphorus and glucose (p <0.05), which was not modified by any type of supplementation protocol under the conditions proposed in this study. The proposed electrolyte supplementation was shown to be limited to prevent electrolyte variations and that the recovery must be evaluated in light of an environmental and training context.

Se evaluó el efecto de la suplementación con una bebida deportiva con carbohidratos y los parámetros de laboratorio en los atletas en el campo de fútbol, en un entrenamiento real. Se recogieron 10 ml de sangre venosa y 50 ml de orina en reposo y 15 minutos después del entrenamiento. Los resultados muestran que el ejercicio intenso causado un grado variable de la estasis urinaria y los cambios de electrolitos causados por una marcada disminución de niveles séricos de sodio, potasio, magnesio, fósforo y glucosa (p <0,05), que no fue modificado por cualquier tipo de protocolo de suplementación en las condiciones propuestas en este estudio. La suplementación de electrolitos propuesta demostró ser limitada para evitar las variaciones de los electrolitos y que la recuperación debe ser evaluada a la luz de un entorno ambiental y de entrenamiento.

Variação aniônica da dieta sobre características ósseas de frangos de corte: resistência à quebra, composição orgânica e mineral / Diet anionic variation in the broiler chick bone: breaking force resistance, organic and mineral composition

Avaliou-se a composição química e a resistência óssea do tibiotarso de frangos de corte aos 21 dias de idade. Foram determinados os percentuais ósseos de proteínas colagenosas (PC) e proteínas não colagenosas (PNC) e de cálcio, fósforo, potássio e sódio. Foram utilizados 650 pintinhos machos de marca comercial, alimentados com dietas à base de milho e farelo de soja. Foi utilizado delineamento em blocos ao acaso com cinco repetições e 26 aves por unidade experimental. Os tratamentos consistiram na suplementação da dieta basal com NH4Cl a fim de se obter cinco níveis -50; 0; 50; 100 e 150mEq/kg de balanço eletrolítico (BE). O nível de BE influenciou os teores de fósforo, potássio, sódio, PC e PNC, relação Ca:P e a resistência à quebra. A redução do balanço eletrolítico da dieta em nível inferior a 150mEq/kg influenciará negativamente a mineralização e a resistência óssea. A resistência à quebra do tibiotarso não está correlacionada com as concentrações dos minerais de forma individual, mas correlaciona-se negativamente com as concentrações de proteínas colagenosas e não colagenosas.

This study was carried out in order to evaluate the bone chemical composition and breaking force resistance of tibiotarsus birds at 21 days of age. The bone percentage of colagenous proteins (CP), non colagenous proteins (NCP) and minerals (calcium, phosphorus, potassium and sodium) was analyzed. A total of 650 commercial male broiler chicks were fed corn and soybean diets. A completely randomized block design with five replications of 26 birds per experimental unit was used. The treatments consisted of the basal ration supplemented with NH4Cl in order to obtain five levels (-50; 0; 50; 100 and 150mEq/kg) of electrolyte balance. The EB level affected the percentages of phosphorus, potassium and sodium, PC and PNC, Ca: P relation and breaking force resistance. The reduction of EB diets at levels below 150mEq/kg will affect negatively the mineralization and bone resistance. The breaking force of tibiotarsus is not correlated with the mineral concentration individually, but correlates negatively with the concentration of collagenous and non-collagenous proteins.

Formiato de sódio em dietas para frangos de corte / Sodium formiate in diets for broilers

O estudo foi conduzido para testar a ação do formiato de sódio sobre o desempenho de frangos de corte. No primeiro experimento, foi avaliado o formiato de sódio em níveis crescentes na dieta e, no segundo, a substituição do cloreto de sódio pelo formiato de sódio, com adição de cloreto de amônia para ajuste do balanço eletrolítico. Aos 7, 14 e 21 dias de idade, foram avaliados o consumo de ração, ganho de peso e conversão alimentar e, aos 7 e aos 21 dias, medidos o consumo de água e a umidade das excretas das aves. Os dados obtidos foram submetidos à análise de variância e comparados pelo teste de Tukey. O desempenho de frangos de corte não é afetado quando o formiato de sódio é utilizado em substituição parcial ou total do cloreto de sódio na dieta. Porém, com a adição do formiato de sódio, deve-se observar o nível de sódio e cloro da dieta, de acordo com as exigências das aves.

This study was developed to evaluate the action of sodium formiate on broiler performance. In the first experiment it was tested the sodium formiate increasing levels in diet, and in the second experiment, it was valuated the replacement of sodium chloride by sodium formiate, with the addition of ammonium chloride for adjustment of electrolyte balance. At 7, 14 and 21 days, feed intake, weight gain and feed conversion were evaluated, and at 7 and 21 days, water intake and excreta moisture were evaluated. The data were submitted to analysis of variance and compared by Tukey test. The performance of broilers is not affected when sodium formate is used in partial or total replacement of sodium chloride in the diet. But with the addition of sodium formate, it should be noted the level of sodium and chlorine in the diet, according to birds' requirement.