Radiation protection effect of furosemide intervention on 18F-FDG PET/CT imaging / 中华放射医学与防护杂志

Objective:To investigate the radiation protection effect of furosemide intervention on 18F-2-deoxy-D-glucose ( 18F-FDG) positron emission tomography/computed tomography (PET/CT) imaging. Methods:A total of 146 patients were randomly divided into two groups, with test group of 74 patients and control group of 72. The test group was administrated orally with furosemide of 40 mg for each one before injection, while the normal control group did not undergo special treatment. 60 and 120 min after 18F-FDG injection, the horizontal measurement of ambient dose equivalent rates was carried out at 0.5 m from the front of both chest and abdomen respectively. Results:For the test group, the ambient dose equivalent rates were measured to be (30.80±8.61) and (41.38±11.06) μSv/h 60 min after injection of 18F-FDG whereas (18.26±4.85) and (24.66±6.50) μSv/h 120 min after injection, respectively, both lower than in the control group and with statistically significant difference between the both ( t =15.36, 13.13, 18.73, 17.29, P<0.05) . No significant difference was found between mediastinal SUV max and liver SUV max in the experimental group and control group ( P>0.05) . Multivariate ANOVA showed that body surface area was a major factor influencing ambient dose equivalent rate regardless of furosemide injection ( t=-13.52, 2.96, P<0.05) , and no obvious effects of age and sex on ambient dose equivalence rate were found. Conclusions:Furosemide intervention can promote urination, effectively reduce the internal radiation exposure of the examinated patietns in the premise of not affecting the image quality, and therefore provide a better radiation protection effect.

Pharmaceutical evaluation of compounded furosemide capsules and excipient performance

Abstract Compounding pharmacies play an important role not only in compounding personalized formulations, but also preparing drugs at the same concentration and dosage as those from commercial manufacturers. The excipients used in compounding are generally standardized for many drugs, however they do not consider the intrinsic properties, such as the poor water solubility, of each substance. The excipient performance of commercially available compounded furosemide capsules in 7 compounding pharmacies from Manaus was evaluated and compared them to the performance of the reference medicinal product (Lasix® tablets) and 2 batches of capsules made in-house (T2 and T4) with a standardized excipient. All batches were subjected to tests for weight variation, assay, uniformity of dosage units, disintegration and dissolution profile. Of the 7 different compound formulas acquired in the compounding pharmacies, only 2 passed all tests. Most formulas passed the tests for weight determination, disintegration time and assay, however batches from 2 establishments failed in regards to the uniformity of the content and 5 batches failed the dissolution test. The reference medicinal product was approved in all tests, as were the T2 capsules made in-house with drug-excipient ratio 1:2. These results confirm the importance of the excipient composition, especially for poorly soluble drugs.

Clinical significance of frusemide stress test in predicting the severity of acute kidney injury / Significância clínica do teste de estresse com furosemida na predição da gravidade da lesão renal aguda

Abstract Introduction: The outcomes of Acute Kidney Injury (AKI) remain dismal even today, owing in part due to the lack of an ideal biomarker for detecting renal damage early enough. We conducted this pilot study to determine the clinical significance of Frusemide Stress Test (FST) to predict the severity of AKI. Methods: A total of 80 patients with AKI-KDIGO (Kidney Disease: Improving Global Outcomes) stage 1 or stage 2 underwent FST by administering a bolus dose of frusemide (1mg/kg for frusemide naïve and 1.5mg/kg for prior frusemide exposure in the past week), and urine output was then measured for the next two hours with volume replacement as desirable. The progression to AKI-KDIGO stage 3 within 14 days of FST was studied as the primary outcome. The composite end point of achieving AKI-KDIGO stage 3 or death within 14 days of FST was studied as the secondary outcome. Results: Out of 80 patients, 28(35%) patients met the primary outcome, and 34(42.5%) patients met the secondary composite outcome. Except for baseline Chronic Kidney Disease (CKD) status (p=0.018), other demographic characteristics were comparable between progressors and non-progressors group. Using receiver operating characteristics (ROC) curve analysis, a cumulative 2-hour post-FST urine output of ≤300 mL predicted progression to stage 3 AKI with 82.14% sensitivity, 82.69% specificity, and AUC of 0.89±0.03 (p<0.0001). Conclusion: The FST showed promising results as a novel tubular biomarker to identify progression to severe AKI with good predictive ability.

Resumo Introdução: Os desfechos da Lesão Renal Aguda (LRA) permanecem desanimadores ainda hoje, em parte pela falta de um biomarcador ideal para detectar danos renais com a devida antecedência. Realizamos este estudo piloto para determinar a importância clínica do Teste de Estresse com Furosemida (TEF) em prever a gravidade da LRA. Métodos: Um total de 80 pacientes com LRA-KDIGO estágio 1 ou 2 foram submetidos ao TEF pela administração de uma dose em bolus de furosemida (1mg/kg para pacientes virgens de furosemida e 1,5mg/kg para exposição prévia à furosemida na semana anterior). O débito urinário foi então medido durante as duas horas seguintes com reposição de volume conforme desejável. A progressão para LRA-KDIGO estágio 3 dentro de 14 dias de TEF foi estudada como principal desfecho. O desfecho composto de atingir a LRA-KDIGO estágio 3 ou óbito em 14 dias após TEF foi estudado como desfecho secundário. Resultados: Dos 80 pacientes, 28 (35%) atingiram desfecho primário, e 34 (42,5%) pacientes atingiram o desfecho composto secundário. Exceto pelo estado basal da Doença Renal Crônica (DRC) (p=0,018), outras características demográficas foram comparáveis entre o grupo progressores e não progressores. Usando a análise da Curva Característica de Operação do Receptor (ROC), um débito urinário cumulativo de 2 horas pós-TEF de ≤300 mL previu a progressão para estágio 3 da LRA com 82,14% de sensibilidade, 82,69% de especificidade, e AUC de 0,89±0,03 (p<0,0001). Conclusão: O TEF mostrou resultados promissores como novo biomarcador tubular para identificar progressão para LRA grave com boa capacidade preditiva.

Effect of small-dose furosemide on tissue edema after shoulder arthroscopy / 中华麻醉学杂志

Objective:To evaluate the effect of small-dose furosemide on tissue edema after shoulder arthroscopy.Methods:A total of 368 patients of either sex, aged 18-65 yr, of American Society of Anesthesiology physical status Ⅰ orⅡ, were divided into 2 groups ( n=184 each) by a random number table method: control group (group C) and small-dose furosemide group (group F). A posterior approach to interscalene brachial plexus block was selected, tracheal intubation was performed under general anesthesia, and all the patients were placed in the lateral position.At 20-30 min before the end of surgery, patients in group F received intravenous injection of furosemide 2 mg (diluted to 2 ml in normal saline) and patients in group C received intravenous injection of normal saline 2 ml.The tissue thickness from the surface of the second rib of the middle clavicular line to the skin (CR2) was measured by ultrasound immediately after nerve block (T 0), immediately after tracheal intubation (T 1), immediately after the end of operation (T 2), and at 30 min and 1, 4 and 8 h after operation (T 3-6). Arterial blood gas analysis was performed at T 1-3, Hct and blood glucose concentration were measured simultaneously, and relative blood volume was calculated.Tube malposition at T 2 and hypoxemia within 30 min after operation were recorded. Results:Compared with the baseline at T 0, CR2 on the affected side was significantly increased at T 2-5 in group F, and CR2 on the affected side was significantly increased at T 2-6 in group C ( P<0.05). CR2 at T 2-5 was significantly higher on the affected side than on the healthy side ( P<0.05). Compared with group C, intraoperative urine volume was significantly increased, CR2 was decreased at T 2-5, the incidence of tube malposition and hypoxemia was decreased ( P<0.05), and no significant changes were found in pH value, PaO 2, PaCO 2, Na + , K + , Ca 2+ , Cl -, blood glucose concentration or relative blood volume at each time point in group F ( P>0.05). Conclusion:Small-dose furosemide can reduce tissue edema after shoulder arthroscopy and decrease the occurrence of postoperative tube malposition and hypoxemia, without causing disturbances in the internal environment.

Influence of Co-Administration of Bioflavonoid on Diuretic Activity of Furosemide

As bioflavonoids have a strong affinity to bind with albumin, it is plausible that they may have the ability to displace the diuretic furosemide bound to albumin. In this study we sought to verify this hypothesis by examining the effect of the co-administration of a bioflavonoid with furosemide on the diuretic activity of the latter. Diosmin is a bioflavonoids type of plant chemical found mainly in citrus fruits.For this purpose, we analyzed bioflavonoids by their ability to bind to human serum albumin (HAS) using an in silico method and found that diosmin had a higher affinity to albumin than furosemide. Subsequently, we investigated the effect of the co-administration of diosmin with furosemide on the diuretic activity of the latter in mice.Our results showed that the combination did not produce any significant change in the diuretic activity of furosemide; however, after 3 hours of treatment, the urine volume of the mice that received diosmin along with frusemide was greater than that of mice administered only the same dose of furosemide. There was no significant difference in urine volume between the two groups at the end of 24 hours. A similar trend of increased levels at 3 hours in the combination group and absence of any difference at 24 hours was noted in the case of the urine concentrations of Na+, K+, and 2 Cl Our findings indicate that co-administration of diosmin increased the immediate diuretic effect of furosemide for the first few hours and that this effect subsides within 24 hrs. Therefore, this combination should be used with care, especially during the first few hours of administration

The Outpatient Use of Furosemide in a Public Hospital

Aim:The prescribing pattern of furosemide helps the prescribers in the monitoring and evaluation of the drugs and helps them in recommending the necessary modifications. So the aimof the present study is to demonstrate the outpatient use of furosemide in a public hospital.Methodology:This is a retrospective study was conducted in a public hospital in Alkharj city. The outpatient prescriptions were reviewed to demonstrate the prescription patternsof furosemide. The study included all outpatient prescriptions that contains furosemide in 2018.Results:Furosemide was prescribed in 46.27% of diuretics prescriptions in the outpatient setting. The majority of the patients were female patients.Most of the patients were more than 39 years old. Most of the furosemide prescriptions were prescribed mainly by resident prescribers, mainly in the cardiology department.Conclusion:Furosemide is an important medication for treating cardiovascular diseases specially in the presence of edema. It is important to increase the awareness of health care professionals and patients regarding the use of furosemide. Moreover, it is important to increase the awareness of the public regarding the importanceof adherence to furosemide

Optimization Of Formulation Of Solid Dispersion Of Furosemide By Factorial Design

Objective: The present study aimed to improve the rate of dissolution of furosemide by solid dispersion technique. Methods: Solid dispersion of furosemide was prepared by using hydrogel isolated from the seeds of Lepidium sativum as a novel carrier by the solvent evaporation method. Solid dispersion was evaluated to study the improvement in the rate of dissolution. Molecular dispersion of furosemide in the novel carrier was studied by DSC and FTIR studies. Solid dispersion was filled in capsules after stability studies and the formulation was optimized by adopting factorial design. Results: Solid dispersion of furosemide exhibited dissolution improvement from 13.54 % (plain furosemide) to 69.12% (solid dispersion) in the first 60 min. Improvement in dissolution efficiency was found to be retained after stability studies. Capsules were filled with the formulation of solid dispersion using two different grades of lactose-α lactose monohydrate and anhydrous lactose and were found stable after stabilization studies. Conclusion: The dissolution improvement of furosemide was attributed to its molecular dispersion in the novel carrier selected for this study. The recrystallization of furosemide was prevented due to intermolecular interaction between the novel carrier and furosemide. This was confirmed by FTIR. Evaluation of the dissolution data of factorial batches was analyzed by ANOVA. Analysis of the data revealed that selected levels of α lactose monohydrate and anhydrous lactose would be useful to navigate design space.

Perfusión de furosemida subcutánea como tratamiento paliativo en insuficiencia cardiaca refractaria / Subcutaneous furosemide infusion as palliative treatment in refractory end-stage heart failure

Resumen En la insuficiencia cardiaca terminal los síntomas predominantes habitualmente están relacionados con la congestión; sin embargo, la resistencia a diuréticos vía oral es frecuente y necesita tratamiento parenteral para paliar los síntomas. La administración intravenosa de furosemida requiere hospitalización o asistencia hospitalaria, lo que supone un deterioro significativo de la calidad de vida de pacientes en fases avanzadas de la enfermedad. La administración subcutánea continua de furosemida mediante infusor elastomérico es una técnica eficaz con baja tasa de complicaciones graves que permite la administración de diurético parenteral en el ámbito domiciliario, y evita la necesidad de hospitalizar. A pesar de que esta modalidad de tratamiento no está aceptada en ficha técnica y requiere más estudios que precisen su indicación, puede suponer un recurso adecuado para pacientes seleccionados. Se presenta el caso de una paciente con insuficiencia cardiaca avanzada, síntomas congestivos y ausencia de respuesta a tratamiento deplectivo vía oral, tratada con perfusión continua subcutánea domiciliaria de furosemida mediante infusor elastomérico de forma prolongada.

Abstract In end-stage heart failure the predominant symptoms are usually associated with congestion. However, the resistance to oral diuretics is common and requires parenteral treatment to alleviate the symptoms. The intravenous administration of furosemide requires hospital admission or hospital care. This leads to a significant decrease in the quality of life of patients in advance stages of the disease. The continuous subcutaneous infusion of furosemide using an elastomeric pump is an effective technique, with a low rate of serious complications that allows a parenteral diuretic to be administered in the home environment and thus avoiding the need for hospital admission. Despite this mode of treatment not being indicated in the drug data sheet, and requires more studies that specify its indication, it may be a suitable recourse for selected patients. It is presented a case of a patient with advanced heart failure, congestive symptoms, and a lack of response to oral diuretics treatment, and then treated with a continuous and prolonged subcutaneous infusion of furosemide at home using an elastomeric infusion pump.

Pharmacological Evaluation Of Antidiabetic And Diuretic Activity Of Hydro-Alcoholic Extract Of Anogeissus Latifolia Bark

The objective of the present investigation was to study the antidiabetic and diuretic potential of Anogeissus latifolia (A. latifolia) bark in experimental rats. The A. latifolia bark was extracted with hydro-alcoholic solvent by cold extraction method. Acute toxicity study was performed according to OECD 425 guidelines for hydro-alcoholic extracts of A. latifolia bark (ALBE). The dose of 150 mg/kg p.o. and 300 mg/kg, p.o. of ALBE was selected for further studies. Animals were prepared diabetic by administration of alloxan (120 mg/kg, i.p.). The albino rats were divided in to five groups for oral glucose tolerance test (OGTT) and alloxan induced anti diabetic model with six animals in each group. Diabetic animals were treated with hydro-alcoholic extract of A. latifolia bark for 20 days. The blood glucose level was estimated according to standard procedures. Diuretic activity hydro-alcoholic extracts of A. latifolia was evaluated by Lipshitz method. The result shows that hydro-alcoholic extract from bark of Anogeissus latifolia 300 mg/kg (ALBE-II) shown significant hypoglycemic activity as compared to glibenclamide and diabetic group. The ALBE does not exhibit significant diuretic activity which is considered as positive marker in diabetic phenomena. Hence in present study extract of A. latifolia posses antidiabetic activity. This study may be benchmark in future to use of this drug scientifically.

Furosemide: Would it help to improve the lungs as evaluated by sonography and compliance during aortic coarctation surgery

Background: We evaluated furosemide on attenuating lung injury and/or edema during coarctation repair surgery. We evaluated dynamic lung compliance. We measured the degree of lung edema by means of lung ultrasound (LUS). We recorded the (PaO2/FiO2ratio) as an indicator for oxygenation. Materials and Methods: A study was conducted on 56 patients. Patients were divided into two groups: control group (Group C) which did not receive furosemide and furosemide group (Group F) at a dose of 1 mg/kg at induction of anesthesia. Dynamic lung compliance was calculated at induction (Cdyn 1) and at the end of the surgery (Cdyn 2). The (PaO2/FiO2ratio) was calculated at start and end of surgery as (PF 1) and (PF 2), respectively. LUS was performed after induction (LUS 1) and at the end of the surgery. LUS 2 using the 12 regions method plotting the results on scale from 0 to 36. Mechanical ventilation days were recorded. Results: Administering furosemide attenuated the lung injury/edema and other pulmonary complications. Furosemide administration improved the dynamic lung compliance in the F Group compared to the C Group. Furthermore, it increased the (PaO2/FiO2ratio) in the F Group compared to the C Group. LUS scale values were lower in the F Group compared to the C Group. There was also less postoperative mechanical ventilation days. Conclusions: The use of furosemide was accompanied by improved lung injury/edema profile as indicated by a much less drop in dynamic lung compliance, better oxygenation, a more favorable LUS scale with less parenchymal lung affection.

Furosemide induced bullous pemphigoid: a case report

Bullous pemphigoid is an acquired autoimmune disease characterized by subepidermal vesicles and bullae. The etiology is mostly idiopathic with the highest occurrence in elderly patients. However, it is now well-accepted that bp has been triggered by or associated with drug therapy. Over 50 agents have been implicated as a cause of Drug-induced bullous pemphigoid, including diuretics, ace inhibitors, and antibiotics. We present a case of Bullous pemphigoid in a 75 year old male probably induced by furosemide. A 75 year old male was admitted to the dermatology department of KIMS hospital, Bengaluru. Presented with multiple tense bullae and vesicles over both upper limbs, forearm and few collapsed bullae and vesicles over the extensor aspect of forearm. Patient had a past history of myocardial infarction and undergone coronary artery bypass grafting for the same and treated with multiple medications. Among the treatment given injection furosemide was the one of the drug, after which he developed lesions and also presented with fluid filled bullae. A diagnosis of bullous pemphigoid was made based on clinical history and was treated with prednisolone, halobetasol and antibiotics. The lesions improved significantly with the above management and patient recovered enough to be discharged from the hospital after 5 days. Severe and serious reactions such as bullous pemphigoid can be caused by used drugs like furosemide.

Uso inapropiado de diuréticos: Algunas características no tan conocidas / Diuretic misuse: Some not so well known characteristics

Entre las situaciones asociadas al uso inapropiado de diuréticos se encuentran los intentos por descencer rápidamente de peso, comunes en los desordenes de la alimentación, y los intentos por enmascarar el consumo de otras sustancias, en el caso de las competencias deportivas. El uso sin indicación ni supervisión médica de estos fármacos genera un desbalance electrolítico, que puede manifestarse con hiponatremia, hipocalemia, hipocalcemia e hipomagnesemia, hipercalemia, entre otras alteraciones. El objetivo de este trabajo fue investigar las caracteríscas del uso inapropiado de diuréticos a partir de la casuística del CENATOXA. Se realizó un estudio descriptivo restrospectivo sobre los análisis ingresados al CENATOXA con solicitud de investigación cualitativa de diuréticos en orina, entre los años 2002 y 2016. En dicho período ingresaron al CENATOXA 138 casos, de los cuales el 56 % resultó positivo para algún diurético. Del total de casos con resultado positivo, el 93,5 % fueron mujeres entre 25 y 55 años de edad y predominó la etiología intencional. Los diuréticos mayoritariamente encontrados fueron hidroclorotiazida y furosemida. El perfil de diuréticos hasta el año 2008 (hidroclorotiazida = 68% de los casos positivos) se diferenció del hallado entre 2009 y 2016 (furosemida + hidroclorotiazida = 60% de los casos positivos). Se observó recurrencia en el uso inapropiado en el 8% de los casos. El uso simultáneo de más de un diurético y la recurrencia son factores que pueden contribuir a la aparición de toxicidad. Estos resultados sugieren que el uso inapropiado de diuréticos es una situación que debería ser ob­servada más atentamente para establecer mejor su alcance y sus riesgos.

Among the situations associated with diuretics misuse are the attempts to lose weight fast, frequently observed in eating disorders, and the attempts to mask the consumption of other substances, in the case of sports competitions. The use of these drugs with no medical indication or supervision generates an electrolyte imbalance, leading to hyponatremia, hypokalemia, hypocalcemia and hypomagnesemia, hyperkalemia, among other alterations. The objective of this work was to investigate the characteristics of diuretics misuse from the CENATOXA database, where the qualitative investigation of diuretics in urine is per­formed. A descriptive retrospective study was conducted on the cases admitted to the CENATOXA with a request for qualitative diuretic investigation, between 2002 and 2016. During this period, 138 urine samples were received at the CENATOXA and 56% were positive for at least one diuretic. Of all cases with positive results, 93.5% were women between 25 and 55 years of age, and intentional etiology predominated. The most detected diuretics were hydrochlorothiazide and furosemide. The diuretic misuse pattern detected up to 2008 (hydrochlorothiazide = 68% of positive cases) differed from that detected between 2009 and 2016 (furosemide + hydrochlorothiazide = 60% of positive cases). Recurrence in misuse was observed in 8% of the cases. The simul­taneous misuse of more than one diuretic and the recurrence are factors that can contribute to the onset of toxicity. These results suggest that diuretic misuse is a situation that should be observed more closely to better assess its consequences and its risks.

Profile of Acute Kidney Injury in Hospitalized Children with Idiopathic Nephrotic Syndrome

Objective: To determine the incidence, risk factors and outcome of acute kidney injury (AKI)in hospitalized children with nephrotic syndrome. Methods: All consecutive hospitalizedchildren (aged 1-14 years) with diagnosis of nephrotic syndrome between February 2016 andJanuary 2017 were enrolled for the study.Children (aged 1-14 years) with features ofnephritis, underlying secondary causes of nephrotic syndrome as well as children admittedfor diagnostic renal biopsy and intravenous cyclophosphamide or rituximab infusion wereexcluded. Results: A total of 73 children (81 admissions) were enrolled; incidence of AKI was16% (95% CI, 9-23). On multivariate logistic regression analysis, furosemide infusion wasobserved as an independent risk factor for acute kidney injury (OR 23; 95% CI, 3-141;P<0.001). Out of 13 children with AKI, three died. Conclusions: Acute kidney injury inhospitalized children with nephrotic syndrome has high risk of mortality. Children receivingfurosemide infusion should be closely monitored for occurrence of acute kidney injury.

Furosemida en el control de la hipertensión arterial posparto en preeclámpticas severas / Furosemide in the control of postpartum hypertension in severe preeclamptic women

RESUMEN OBJETIVO: Establecer la utilidad de la furosemida en el control de la hipertensión arterial posparto en preeclámpticas severa. MÉTODOS: Se realizó un estudio de casos y controles en el Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Se incluyeron pacientes con preeclampsia severa, las cuales durante el posparto fueron asignadas al azar para ser tratadas con furosemida, alfametildopa y cloruro de potasio oral (grupo A) o alfa-metildopa oral (grupo B) por 48 horas. Los parámetros evaluados fueron: variaciones en los valores de presión arterial y frecuencia cardiaca, persistencia de hipertensión, parámetros de laboratorio y efectos adversos. RESULTADOS: Para el análisis final estaban disponibles los datos de 198 pacientes en el grupo A y 197 pacientes en el grupo B en cada uno de los grupos. Luego de 48 horas de tratamiento se observaron disminuciones estadísticamente significativas en los valores de presión arterial sistólica y diastólica entre las pacientes tratadas con furosemida y las pacientes del grupo control (p < 0,0001). Se observó persistencia de la hipertensión en 52 pacientes (26,3 %) del grupo A y en 134 pacientes (68,0 %) del grupo B (p < 0,0001). No se encontraron diferencias entre los grupos en la frecuencia cardiaca, valores de laboratorio y efectos adversos (p = ns). CONCLUSIÓN: La furosemida produce disminuciones significativas en los valores promedios de presión arterial sistólica y diastólica, al igual que en la frecuencia de persistencia de hipertensión postparto en preeclámpticas severas.

ABSTRACT OBJECTIVE: To establish the utility of furosemide in the control of postpartum blood pressure in severe preeclamptic patients. METHODS: A case-control study was conducted at the Central Hospital "Dr. Urquinaona", Maracaibo, Venezuela. Patients diagnosed with severe preeclampsia were included, who during the postpartum period were randomized to be treated with furosemide, alpha-methyldopa and oral potassium chloride (group A) or oral alpha-methyldopa (group B) for 48 hours. The parameters evaluated were: variations in blood pressure and heart rate values, the persistence of hypertension, laboratory parameters and adverse effects related to treatment. RESULTS: Data of 198 patients in group A and 197 patients in group B in each of the groups were available for the final analysis. After 48 hours of treatment, statistical significant decreases were observed in the values of systolic and diastolic blood pressure between patients treated with furosemide and patients in the control group (p <0.0001). Persistence of hypertension was observed in 52 patients (26.3 %) of group A and in 134 patients (68.0 %) of group B (p < 0.0001). No differences were found between the groups in heart rate, laboratory values and adverse effects (p = ns). CONCLUSION: Furosemide produces significant decreases in the mean values of systolic and diastolic blood pressure, as well as in the frequency of persistence of postpartum hypertension in severe preeclamptic patients.

Effects of ulinastatin combined with furosemide on myocardial enzymes,renal function and adverse reactions in patients with acute renal failure after cardiopulmonary resuscitation / 中国基层医药

Objective To explore the effects of ulinastatin combined with intravenous pump injection of furosemide on myocardial enzymes ,renal function and adverse reactions in patients with acute renal failure ( ARF) after cardiopulmonary resuscitation (CPR).Methods From January 2016 to May 2018,117 patients with ARF after successful CPR in the Second Peopleˊs Hospital of Hefei were divided into observation group ( n ＝59) and control group(n＝58) using simple random method.The control group received routine treatment ,while the observation group added ulinastatin combined with intravenous pump infusion of furosemide .Myocardial enzymology, renal function, metabolism,inflammatory index,adverse reaction and survival rate were compared.Results Three and 7 days after treatment,the hydroxybutyrate dehydrogenase ( HDBH), isoenzymes of creatine kinase isoenzyme ( CK －MB) and mitochondrial aspartate aminotransferase isoenzyme (m－AST) were decreased in the two groups ,and compared with the control group,which of the observation group were lower [HDBH:(231.42 ±31.15)U／L vs.(268.59 ±34.87)U／L; F＝12.01,P＝0.00;CK－MB:(32.38 ±4.15)ng／mL vs.(37.57 ±3.96) ng／mL;F＝15.12,P＝0.00;m－AST:(25.18 ±4.24) U／L vs.(33.92 ±5.60) U／L;F＝12.36,P＝0.00].After treatment,the blood urea nitrogen (BUN),24h urine protein quantity and creatinine ( Cr) in the two groups increased firstly and then decreased ,and compared with the control group ,those of the observation group were lower [BUN:(7.02 ±1.66)mmol／L vs.(8.47 ± 1.38)mmol／L;F＝11.24,P＝0.00;Cr:(82.69 ±9.87) μmol／L vs.(90.18 ±10.37) μmol／L;F＝10.39,P＝0.00;24h urine protein quantity:(15.43 ±2.17) mg vs.(18.62 ±3.14) mg;F＝11.06,P＝0.00].Three and 7 days after treatment,the levels of blood lactic acid (Lac),hypersensitive C－reactive protein(hs－CRP) and tumor necrosis factor－α( TNF－α) were decreased in the two groups ,and compared with the control group ,those of the observation group were lower [ Lac:(1.18 ±0.27) mmol／L vs.(2.17 ±0.34) mmol／L,F ＝16.29, P ＝0.00;hs－CRP:(4.89 ±0.81)mg／L vs.(6.17 ±1.10) mg／L,F＝13.41,P＝0.00;TNF－α:(72.18 ±7.62) ng／L vs. (83.16 ±7.79)ng／L,F＝11.39,P＝0.00].The incidence rates of adverse reactions in the observation group and the control group were 5.09% and 1.72%,respectively,the difference was statistically significant (χ2 ＝0.24,P＝0.62).The survival rates in the observation group and the control group were 50 cases (84.75%) and 39 cases (67.24%) respectively,the difference was statistically significant (χ2 ＝4.92,P＝0.02).Conclusion Intravenous pump injection of furosemide combined with ulinastatin can protect the heart and kidney ,and improve the survival rate of patients with ARF after CPR and it is worthy of popularizing.

Influence of Rho kinase inhibitor combined furosemide and spironolactone on cardiac function , serum levels of AST , LDH and CK‐MB in patients with acute left heart failure／ / 心血管康复医学杂志

To explore application value of Rho kinase inhibitor (RKI) combined furosemide and spironolactone in patients with acute left heart failure (ALHF).Methods : A total of 94 ALHF patients were randomly and equally divided into diuretic group (received furosemide and spironolactone based on routine treatment ) and triple therapy group (received RKI‐‐fasudil hydrochloride based on diuretic group ) , both groups were continuously treated for 7d.LVESV , LVEDV , LVEF ,serum levels of aspartate transaminase (AST) , lactate dehydrogenase (LDH) and creatine kinase isoenzyme MB (CK‐MB) before and after treatment , therapeutic effects were observed and compared between two groups .Results : Total effective rate of triple therapy group was significantly higher than that of diuretic group (95.75% vs.82.98%) , P＝0.045. Compared with before treatment , there was significant rise in LVEF , and significant reductions in LVESV , LV‐EDV ,serum levels of AST , LDH and CK‐MB in two groups after treatment , P＝0.001 all ;compared with diuretic group after treatment , there was significant rise in LVEF [ (48.27 ± 5.95)% vs.(55.14 ± 6.74)%] , and significant reductions in LVESV [ (86.29 ± 10.41) ml vs.(65.96 ± 9.84) ml] , LVEDV [ (133.71 ± 13.42) ml vs.(120.35 ± 11.25) ml] , serum levels of AST [ (81.23 ± 10.44) U／L vs.(57.58 ± 8.42) U／L] , LDH [ (184.24 ± 13.51) U／Lvs.(124.65 ± 12.42) U／L] and CK‐MB [ (187.84 ± 13.45) U／L vs.(132.54 ± 11.69) U／L] in triple therapy group , P＝0.001 all. There was no significant difference in adverse reactions during treatment between two groups , P＞0.05 both .Conclusion :Rho kinase inhibitor combined furosemide and spironolactone can significantly improve cardiac function and reduce myocar ‐dial damage , and it＇s safe and reliable , which is worth extending .

Effects of dehydration on echocardiographic diastolic parameters in healthy cats

This study aimed to assess the effects of dehydration on echocardiographic indices in healthy cats: specifically, it aimed to assess the effects of volume depletion on diastolic function. Nine experimental cats were subjected to both a dehydration and placebo protocol separated by a 21-day washout period. Echocardiography was performed at baseline and on completion of each protocol. Results were compared between the two protocols. Volume depletion was induced by intravenous administration of furosemide. Volume depletion showed a significant association with increased interventricular septal and left ventricular free wall thickness at end-diastole, decreased left ventricular internal diameter at end-diastole, and left atrial diameter at end-systole. The peak early (E) and late (A) diastolic filling velocities, and the peak early diastolic velocities (E′) were significantly decreased by dehydration. Volume depletion did not affect peak longitudinal strain rate during early diastole, E/A, or E/E′. Volume depletion significantly affected the echocardiographic diastolic indices and conventional echocardiographic parameters in healthy cats.

Efficacy of triple diuretic treatment in continuous ambulatory peritoneal dialysis patients: A randomized controlled trial

BACKGROUND: The efficacy of combined diuretic treatment in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) is not known. METHODS: In a single-center, double-blinded, randomized controlled trial, we randomly assigned 51 adult CAPD patients to receive furosemide 1,000 mg/day, hydrochlorothiazide 100 mg/day, and spironolactone 50 mg/day (triple diuretics [TD] group) or furosemide 1,000 mg/day plus placebo (single diuretic [SD] group) for 6 months. The primary outcome was the difference in daily urine output at the 3rd and 6th month of the study compared to baseline (ΔUO) between the SD and TD group. Secondary outcomes were urinary sodium (UNa) and potassium (UK) excretion and overhydration (OH) measured by bioimpedance at 3 and 6 months compared to baseline (ΔUNa, ΔUK, and ΔOH, respectively) and daily glucose exposure (g/day). RESULTS: Forty-three of 51 patients completed the 6-month trial. The ΔUO at 3 and 6 months was significantly higher in the TD group compared to the SD group (386.32 ± 733.92 mL/day vs. −136.25 ± 629.08 mL/day, P < 0.001, at 3 months; 311.58 ± 640.31 mL/day vs. 120.00 ± 624.07 mL/day, P < 0.001, at 6 months) but there was no significant difference in ΔUNa and ΔUK excretion. Hydration status was significantly better in the TD group (ΔOH 1.84 ± 2.27 L vs. 0.44 ± 1.62 L, P = 0.03, at 3 months; 1.49 ± 2.82 L vs. −0.48 ± 2.61 L, P = 0.02, at 6 months). There was no serious adverse event in this study. CONCLUSION: For end-stage renal disease patients on CAPD, the combination of furosemide, hydrochlorothiazide, and spironolactone results in higher urine output and better volume control compared to furosemide alone.

Effects of ulinastatin combined with furosemide on myocardial enzymes, renal function and adverse reactions in patients with acute renal failure after cardiopulmonary resuscitation / 中国基层医药

Objective@#To explore the effects of ulinastatin combined with intravenous pump injection of furosemide on myocardial enzymes, renal function and adverse reactions in patients with acute renal failure(ARF) after cardiopulmonary resuscitation(CPR).@*Methods@#From January 2016 to May 2018, 117 patients with ARF after successful CPR in the Second People's Hospital of Hefei were divided into observation group(n=59) and control group(n=58) using simple random method.The control group received routine treatment, while the observation group added ulinastatin combined with intravenous pump infusion of furosemide.Myocardial enzymology, renal function, metabolism, inflammatory index, adverse reaction and survival rate were compared.@*Results@#Three and 7 days after treatment, the hydroxybutyrate dehydrogenase(HDBH), isoenzymes of creatine kinase isoenzyme(CK-MB) and mitochondrial aspartate aminotransferase isoenzyme(m-AST) were decreased in the two groups, and compared with the control group, which of the observation group were lower [HDBH: (231.42±31.15)U/L vs.(268.59±34.87)U/L; F=12.01, P=0.00; CK-MB: (32.38±4.15)ng/mL vs.(37.57±3.96)ng/mL; F=15.12, P=0.00; m-AST: (25.18±4.24)U/L vs.(33.92±5.60)U/L; F=12.36, P=0.00]. After treatment, the blood urea nitrogen(BUN), 24h urine protein quantity and creatinine(Cr) in the two groups increased firstly and then decreased, and compared with the control group, those of the observation group were lower[BUN: (7.02±1.66)mmol/L vs.(8.47±1.38)mmol/L; F=11.24, P=0.00; Cr: (82.69±9.87)μmol/L vs.(90.18±10.37)μmol/L; F=10.39, P=0.00; 24h urine protein quantity: (15.43±2.17)mg vs.(18.62±3.14)mg; F=11.06, P=0.00]. Three and 7 days after treatment, the levels of blood lactic acid(Lac), hypersensitive C-reactive protein(hs-CRP) and tumor necrosis factor-α(TNF-α) were decreased in the two groups, and compared with the control group, those of the observation group were lower [Lac: (1.18±0.27)mmol/L vs.(2.17±0.34)mmol/L, F=16.29, P=0.00; hs-CRP: (4.89±0.81)mg/L vs.(6.17±1.10)mg/L, F=13.41, P=0.00; TNF-α: (72.18±7.62)ng/L vs.(83.16±7.79)ng/L, F=11.39, P=0.00]. The incidence rates of adverse reactions in the observation group and the control group were 5.09% and 1.72%, respectively, the difference was statistically significant(χ2=0.24, P=0.62). The survival rates in the observation group and the control group were 50 cases (84.75%) and 39 cases (67.24%) respectively, the difference was statistically significant(χ2=4.92, P=0.02).@*Conclusion@#Intravenous pump injection of furosemide combined with ulinastatin can protect the heart and kidney, and improve the survival rate of patients with ARF after CPR and it is worthy of popularizing.