Clinical effect of different maintenance doses of caffeine citrate in the treatment of preterm infants requiring assisted ventilation: a pilot multicenter study / 中国当代儿科杂志

OBJECTIVES@#To explore the optimal maintenance dose of caffeine citrate for preterm infants requiring assisted ventilation and caffeine citrate treatment.@*METHODS@#A retrospective analysis was performed on the medical data of 566 preterm infants (gestational age ≤34 weeks) who were treated and required assisted ventilation and caffeine citrate treatment in the neonatal intensive care unit of 30 tertiary hospitals in Jiangsu Province of China between January 1 and December 31, 2019. The 405 preterm infants receiving high-dose (10 mg/kg per day) caffeine citrate after a loading dose of 20 mg/kg within 24 hours after birth were enrolled as the high-dose group. The 161 preterm infants receiving low-dose (5 mg/kg per day) caffeine citrate were enrolled as the low-dose group.@*RESULTS@#Compared with the low-dose group, the high-dose group had significant reductions in the need for high-concentration oxygen during assisted ventilation (P=0.044), the duration of oxygen inhalation after weaning from noninvasive ventilation (P<0.01), total oxygen inhalation time during hospitalization (P<0.01), the proportion of preterm infants requiring noninvasive ventilation again (P<0.01), the rate of use of pulmonary surfactant and budesonide (P<0.05), and the incidence rates of apnea and bronchopulmonary dysplasia (P<0.01), but the high-dose group had a significantly increased incidence rate of feeding intolerance (P=0.032). There were no significant differences between the two groups in the body weight change, the incidence rates of retinopathy of prematurity, intraventricular hemorrhage or necrotizing enterocolitis, the mortality rate, and the duration of caffeine use (P>0.05).@*CONCLUSIONS@#This pilot multicenter study shows that the high maintenance dose (10 mg/kg per day) is generally beneficial to preterm infants in China and does not increase the incidence rate of common adverse reactions. For the risk of feeding intolerance, further research is needed to eliminate the interference of confounding factors as far as possible.

Recent research on gene polymorphisms related to caffeine therapy in preterm infants with apnea of prematurity / 中国当代儿科杂志

Apnea of prematurity (AOP) is one of the common diseases in preterm infants. The main cause of AOP is immature development of the respiratory control center. If AOP is not treated timely and effectively, it will lead to respiratory failure, hypoxic brain injury, and even death in severe cases. Caffeine is the first choice for the treatment of AOP, but its effectiveness varies in preterm infants. With the deepening of AOP research, more and more genetic factors have been confirmed to play important roles in the pathogenesis and treatment of AOP; in particular, the influence of single nucleotide polymorphism on the efficacy of caffeine has become a research hotspot in recent years. This article reviews the gene polymorphisms that affect the efficacy of caffeine, in order to provide a reference for individualized caffeine therapy. Citation.

Challenges of nanotechnology in cosmetic permeation with caffeine / Desafios da nanotecnologia na permeação cosmética com cafeína

The evolution of beauty market and personal care is constant in Brazil as well in the rest of the world. Technological advances have brought up nanotechnology to the cosmetological field, employing active principles at atoms enveloped by vesicles, in order to take the active principle precisely to the target tissue to optimize the results achieved because of the considerable ease to cross skin barriers. Manufacturing of nanotechnology cosmetics is confronted with low absorption capacity. One of the many active principle found in cosmetic industry is caffeine, a pseudoalkaloid from the xanthine group used as a stimulant with the mechanism of the lipolytic action. This active is widely used in a esthetics and cosmetics field in treatments involving dysfunctions such as localized fat and fibroedema geloid. To work out perfectly, the principle active need to interact and create a set of factors that includes lipolysis intensification. The caffeine encapsulation in gel-based nanocosmetics has the purpose of taking this active up to the adipocyte, the target cell, for mentioned dysfunctions treatment. Thus, we aim to present a review of how has been, the use of caffeine in the production of cosmetics.

A evolução do mercado de beleza e cuidados pessoais é constante no Brasil e no resto do mundo. Os avanços tecnológicos trouxeram a nanotecnologia para o campo cosmetológico, empregando princípios ativos em átomos envolvidos por vesículas, a fim de levar o princípio ativo precisamente ao tecido alvo para otimizar os resultados alcançados devido à considerável facilidade de atravessar barreiras cutâneas. A fabricação de cosméticos nanotecnológicos é confrontada com baixa capacidade de absorção. Um dos muitos princípios ativos encontrados na indústria cosmética é a cafeína, um pseudoalocalóide do grupo xantina usado como estimulante no mecanismo da ação lipolítica. Este ativo é amplamente utilizado no campo da estética e dos cosméticos em tratamentos que envolvem disfunções, como gordura localizada e fibroedema gelóide. Para funcionar perfeitamente, o princípio ativo precisa interagir e criar um conjunto de fatores que inclui a intensificação da lipólise. O encapsulamento de cafeína em nanocosméticos à base de gel tem o objetivo de levar esse ativo até o adipócito, a célula alvo, para o tratamento de disfunções mencionado. Assim, objetivamos apresentar uma revisão de como tem sido o uso de cafeína na produção de cosméticos.

Quality of cosmetics with active caffeine in cream and gel galenic bases prepared by compounding pharmacies / Qualidade de cosméticos com cafeína ativa em bases galênicas em creme e gel preparadas por farmácias de manipulação

As there is a great scarcity of studies on the importance of good compounding practices in the preparation of cosmetics, this study aimed to evaluate the quality control of cosmetics with active ingredient caffeine for the treatment of cellulite prepared by magistrals pharmacies. Microbiological analyzes, pH determination, color measurement, quantification of the percentage of the active ingredient caffeine and viscosity in creams and gels with 5% of the active ingredient caffeine were performed. In the microbiological analysis, the presence of molds and yeasts was verified above the permitted level according to the Brazilian pharmacopoeia. The pH decreased over time, contributing to the formulations becoming more acidic. In the color parameters, it was found that pharmacy F4 showed a brownish color, both for the gel and for the cream. The percentage of caffeine was within specifications in all formulations and the viscosity remained unchanged during the shelf life of the samples. It is important that the compounding pharmacies demand more effectively the commitment of the team, as well as the analysis of the raw material according to the microbiological control regulations to translate into the quality of the products prepared by the pharmacies and favor the consumer in the effective objective that the product you want to achieve.

Como há uma grande escassez de estudos sobre a importância de boas práticas de manipulação na elaboração de cosméticos, o presente estudo teve como objetivo avaliar o controle de qualidade de cosméticos com princípio ativo cafeína para o tratamento de celulite, elaborados por farmácias de manipulação de Campo Mourão. Foram realizadas análises microbiológicas, determinação do pH, mensuração da coloração, quantificação da porcentagem do princípio ativo cafeína e viscosidade em cremes e geís com 5% do princípio ativo cafeína. Nas análises microbiológicas foi verificada a presença de bolores e leveduras acima do pemitido segundo a farmacopéia brasileira. O pH diminuiu ao longo do tempo, contribuindo para que as formulações ficassem mais ácidas. Nos parâmetros de cor averiguou-se que a farmácia F4 apresentou uma coloração amarronzada, tanto para o gel quanto para o creme. A porcentagem de cafeína estava dentro das especificações em todas as formulações e a viscosidade se manteve inalterada durante o prazo de validade das amostras. Com o propósito de um melhor preparo magistral é importante que as farmácias de manipulação exijam de forma mais eficaz o comprometimento da equipe, bem como a análise da matéria-prima segundo as regulamentações de controle microbiológico. Além disso, a implementação de normas mais rígidas e o melhor controle da matéria-prima e das formulações finais fazem com que a qualidade dos produtos manipulados pelas farmácias magistrais seja aumentada significativamente, favorecendo o consumidor na efetiva finalidade a que o produto objetiva atingir.

Coadministration of ibuprofen/caffeine on bleaching-induced tooth sensitivity: A randomized clinical trial

Abstract This clinical trial evaluated the effect of the coadministration of ibuprofen/caffeine on bleaching-induced tooth sensitivity (TS). A triple-blind, parallel-design, randomized clinical trial was conducted on 84 patients who received ibuprofen/caffeine or placebo capsules. The drugs were administered for 48 hours, starting 1 hour before the in-office bleaching. Two bleaching sessions were performed with 35% hydrogen peroxide gel with 1-week interval. TS was recorded up to 48 hours after dental bleaching with a 0-10 visual analogic scale (VAS) and a 5-point numeric rating scale (NRS). The color was evaluated with VITA Classical and VITA Bleachedguide scales (ΔSGU) and VITA Easyshade spectrophotometer (ΔE*ab and ΔE00). The absolute risk of TS in both groups was evaluated using Fischer's exact test. Comparisons of the TS intensity (NRS and VAS data) were performed by using the Mann-Whitney test and a two-way repeated measures ANOVA, respectively. The color alteration between the groups was compared with the Student's t test. The significance level was 5%. There was no statistically significant difference between the groups for the absolute risk of TS (p = 1.00) or for the intensity of TS (p > 0.05). A bleaching of approximately 7 shade guide units was observed on the Vita Classical and Vita Bleachedguide scales, with no statistical difference between the groups. It was concluded that coadministration of ibuprofen and caffeine did not reduce the absolute risk or intensity of TS and did not interfere with the efficacy of dental bleaching.

Resumo Este ensaio clínico avaliou o efeito da coadministração de ibuprofeno/cafeína na sensibilidade dental decorrente de clareamento (SD). Um estudo clínico randomizado, paralelo, triplo-cego, foi realizado em 84 pacientes que receberam cápsulas de ibuprofeno/cafeína ou placebo. Os fármacos foram administrados por 48 horas, começando 1 hora antes do clareamento em consultório. Duas sessões de clareamento foram realizadas com gel de peróxido de hidrogênio 35% com intervalo de 1 semana. A SD foi registrada até 48 horas após o clareamento dental com uma escala visual analógica (VAS) de 0-10 e uma escala de classificação numérica (NRS) de 5 pontos. A cor foi avaliada com as escalas Vita Classical e Vita Bleachedguide (ΔSGU) e com o espectrômetro Vita Easyshade (ΔE*ab e ΔE00). O risco absoluto de SD em ambos os grupos foi avaliado por meio do teste exato de Fischer. As comparações da intensidade da SD (NRS e VAS) foram realizadas utilizando-se o teste Mann-Whitney e uma ANOVA de dois fatores com medidas repetidas, respectivamente. A alteração de cor entre os grupos foi comparada com a o teste t de Student. O nível de significância foi de 5%. Não houve diferença estatisticamente significante entre os grupos para o risco absoluto de SD (p = 1,00) ou para a intensidade de SD (p > 0,05). Observou-se clareamento de aproximadamente 7 unidades nas escalas Vita Classical e Vita Bleachedguide, sem diferença estatística entre os grupos. Concluiu-se que a coadministração de ibuprofeno e cafeína não reduziu o risco absoluto ou intensidade da SD e não interferiu na eficácia do clareamento dental.

Intubación al nacer con tubo nasal corto en la transición a la vida extrauterina en recién nacidos de muy bajo peso / Intubation with a short nasal tube at birth during the transition to extrauterine life in very low birth weight infants

Describimos cambios recientes en el cuidado convencional al nacer en recién nacidos de muy bajo peso al nacer y la utilización de un tubo nasal corto para apoyar la ventilación inicial en este nuevo contexto. Reportamos nuestra experiencia con los tres primeros casos en que usamos esta técnica simple para administrar nCPAP a recién nacidos durante el alumbramiento mientras existe función placentaria antes de cortar el cordón.

We describe recent changes in conventional care at birth of very low birth weight infants and the use of a short nasal tube to support ventilation. We report our experience in the first three cases with this simple technique to deliver nCPAP to newborn infants during the third stage of labour, while the placenta is still functioning and before cutting the cord

Incremento na dissolução da caffeine em base de ammonium acryloyldimethyltaurate/vp copolymer: desenvolvimento farmacotécnico de géis anti-celulite / Dissolution enhancement of caffeine in the ammonium acryloyldimethyltaurate/vp copolymer base: pharmaceutical development of anti-cellulite gels

A hidrolipodistrofia ginóide (HLDG), popularmente conhecida como ?celulite?, consiste em uma alteração patológica do tecido adiposo e da função veno- linfática. Géis contendo caffeine tem sido empregados no tratamento não-invasivo da HLDG, oferecendo resultados satisfatórios a baixos custos. Devido a baixa hidrossolubilidade da caffeine, este gel apresenta como principal inconveniente a formação de precipitados/ grumos, oriundos da precipitação da caffeine na base hidrofílica (gel). Este trabalho tem como objetivo o incremento na dissolução da caffeine em gel de Ammonium Acryloyldimethyltaurate/VP Copolymer, através da adição de adjuvantes como o citric acid e o sodium benzoate, além de solução hidroalcoólica, empregada como co-solvente da caffeine. O incremento na dissolução da caffeine foi verificado através da determinação do seu teor nos géis. Além disso, todas as amostras foram submetidas a análises macroscópicas e determinações de pH e viscosidade. A análise macroscópica permitiu a nítida visualização dos precipitados/grumos nos géis preparados sem os adjuvantes, enquanto que o emprego dos mesmos originou géis sem a presença de precipitados. A determinação do teor de caffeine demonstrou que os adjuvantes e co-solvente quase dobraram a concentração deste ativo nos géis. O pH do gel e a concentração de citric acid não influenciaram na dissolução da caffeine. Por outro lado, esses parâmetros influenciaram negativamente na viscosidade dos géis, o que parece ter sido ocasionado pela instabilidade do ammonium acryloyldimethyltaurate/VP copolymer em valores baixos de pH. Com isso, o aumento na dissolução da caffeine no gel anti-celulite parece ter sido ocasionada pela formação de sais hidrossolúveis com os adjuvantes empregados.(AU)

Gynoid hydrolipodystrophy, popularly known as cellulite, is a pathological alteration of the adipose tissue and the venous-lymphatic system. Gels containing caffeine has been used as a non-invasive treatment of cellulite offering satisfactory results at low costs. Due to the low aqueous solubility of caffeine, this gel has a major drawback, which is the formation of a drug precipitate in the hydrophilic excipient (ammonium acryloyldimethyltaurate/VP copolymer gel). The aim of this work is to increase the dissolution of caffeine in the gel by adding adjuvants such as citric acid and sodium benzoate, as well as a water-alcohol solution as a co-solvent for caffeine. The increase in the dissolution of caffeine was verified by determining its content in the gel. In addition, all samples were subjected to macroscopic analysis, pH determinations and viscosity measurements. Macroscopic analysis allowed a clear visualization of a white precipitate in the gels prepared without the adjuvants, whereas the use of both adjuvants and the water-alcohol solution avoided the precipitation of caffeine. Determination of caffeine content showed that the adjuvants and co-solvent nearly doubled the concentration of this drug in the gels. The pH of the gel and the concentration of citric acid did not influence the dissolution of caffeine, whereas the viscosity of the gel was negatively influenced by these parameters, which seems to be caused by the instability of ammonium acryloyldimethyltaurate/VP copolymer at low pH. Thus, the increase in the dissolution of caffeine seems to have been caused by the formation of water-soluble salts with the adjuvants used.(AU)

Café: uma bebida rica em substâncias com efeitos clínicos importantes, em especial a cafeína / Coffee: a beverage rich in substances with important clinical effects, especially caffeine

O café é uma das bebidas mais populares do mundo, chegando ao consumo aproximado de 6,7 milhões de toneladas por ano. Há certo tempo, alguns dos seus efeitos fisiológicos, relacionados a uma gama de substâncias encontradas na bebida, estão sendo amplamente estudados. Alguns estudos destacam a cafeína como uma substância fundamental para os efeitos estudados desta bebida. O trabalho objetivou discernir e ressaltar alguns efeitos clínicos relevantes da cafeína. Nesse sentido, foi realizada uma busca de trabalhos que valorizam as propriedades clínicas do café, que ressaltam algumas de suas substâncias, e estudos específicos sobre a cafeína, que a atribuem uma abordagem clínica. Foram definidos pelos autores alguns aspectos positivos e negativos dos efeitos clínicos provocados pela cafeína. Assim, reforça-se a discussão sob as perspectivas de uso da cafeína, seja na alimentação, como medicamento ou em estudos de parâmetros clínicos para diabetes tipo 2, arritmias, parada cardíaca, infarto agudo não fatal do miocárdio, Parkinson e Alzheimer. É preciso atribuir, nesse contexto, certa ponderação ao seu uso, relevando a vulnerabilidade do indivíduo e as manifestações clínicas atribuídas à cafeína...

Coffee is one of the most popular beverages in theworld, with an approximate consumption of 6.7 million tons per year. Some of the physiological effects of a variety of substances found in the beverage are being widely studied. Some research highlights caffeine as a substance crucial to coffee?s biological effects. The aim of this study was to discern and highlight some of the relevant clinical effects of caffeine. To this end, we made a search for studies related to the clinical properties of coffee, which highlighted some of its main substances, and studies specifically about caffeine, which followed a clinical approach. The authors defined some positive and negative features of the clinical effects provoked by caffeine. Thus, the prospects of using caffeine, in food, as a medicine or in clinical parameter studies of type 2 diabetes, arrhythmia, cardiac arrest, nonfatal acute myocardial infarction, Parkinson and Alzheimers disease, were well discussed. In this context, it is very important to give responsible consideration to theuse of caffeine, keeping in mind the vulnerability of the individual and the clinical manifestations of this substance...

Apnoea of Prematurity : Discontinuation of Methylxanthines in a Resource-Limited Setting

Background. Methylxanthines such as caffeine have been proven to reduce apnoea of prematurity and are often discontinued at 35 weeks' corrected gestational age (GA).Objective. To ascertain whether a caffeine protocol based on international guidelines is applicable in our setting; where GA is often uncertain.Methods. A prospective folder review was undertaken of all premature infants discharged home over a 2-month period.Results. Fifty-five babies were included. All babies born at less than 35 weeks' GA were correctly started on caffeine as per protocol. GA was assigned in 85.5 of cases by Ballard scoring and in 14.5 from antenatal ultrasound findings. Caffeine was discontinued before 35 weeks in 54.5 Discussion. The main reason for discontinuing caffeine early was the baby's ability to feed satisfactorily; a demonstration of physiological maturity. As feeding behaviours mature significantly between 33 and 36 weeks; the ability to feed may be a good indication that caffeine therapy can be stopped

Effect of the chronic administration of caffeine on adipose mass and lipid profile of Wistar rats / Efeito da administração crônica de cafeína na massa adiposa e no perfil lipídico de ratos Wistar

This work aimed at verifying the effect of the chronic ingestion of caffeine on body weight and adiposity of Wistar rats. Sixteen male Wistar rats weighting on average 240 g were divided into two groups, one control and the other caffeine -treated (5 mg kg-1, orally) for five weeks. At the end, the groups were evaluated for their differences in body weight; weight of the periepididymal, retroperitoneal, subcutaneous and mesenteric fat pads; size of the retroperitoneal adipocytes; liver and heart weight; glycemia and plasma lipids. Statistically significant differences were observed in adipocyte size and total serum cholesterol, while the results for the other parameters were not statistically different. Therefore, this study showed that, using an oral dose of caffeine within acceptable (non toxic) limits, it is possible to reduce the size of adipocytes of non-obese Wistar rats, as well as to reduce the serum cholesterol levels, even in the absence of physical activity or other active compounds.

Este trabalho teve como objetivo verificar o efeito da ingestão crônica de cafeína no peso corporal e na adiposidade de ratos Wistar. Foram utilizados 16 ratos Wistar machos com peso em torno de 240 g divididos em dois grupos, um controle e outro tratado com cafeína (5 mg kg-1, via oral) por cinco semanas. Ao final, foi avaliada a diferença entre os dois grupos em relação ao peso corporal; ao peso dos depósitos de gordura periepididimal, retroperitoneal, subcutânea e mesentérica; ao tamanho dos adipócitos retroperitoneais; ao peso do coração e do fígado; e aos valores de glicemia e lipídeos plasmáticos. Foram observadas diferenças estatisticamente significativas no tamanho dos adipócitos e na quantidade plasmática de colesterol total, sendo que o resultado das demais variáveis não foi significativo. Portanto, este estudo mostrou que, usando uma dose oral de cafeína dentro dos limites considerados aceitáveis (não-tóxicos), é possível reduzir o tamanho dos adipócitos de ratos Wistar não-obesos, bem como reduzir seus níveis séricos de colesterol, mesmo na ausência de atividade física ou de outros compostos ativos.

Cafeína para o tratamento de dor / Caffeine in the treatment of pain / Cafeína para el tratamiento del dolor

JUSTIFICATIVA E OBJETIVOS: A cafeína é uma substância amplamente consumida com efeitos em diversos sistemas e que apresenta farmacocinética e farmacodinâmica características, causando interações com diversos medicamentos. O objetivo deste estudo é fazer uma revisão sobre os efeitos da cafeína. CONTEÚDO: Nesta revisão, são abordados a farmacologia da cafeína, os mecanismos de ação, as indicações, as contraindicações, as doses, as interações e os efeitos adversos. CONCLUSÕES: Faltam estudos controlados, randomizados e duplos-cegos para avaliar a eficácia analgésica da cafeína nas diversas síndromes dolorosas. Em pacientes com dor crônica, é necessário ter cautela em relação ao desenvolvimento de tolerância, abstinência e interação medicamentosa no uso crônico de cafeína.

BACKGROUND AND OBJECTIVES: Caffeine is a widely used substance with effects on several systems, presenting characteristic of pharmacokinetic and pharmacodynamic which cause interactions with several drugs. This study's objective is to review the effects caused by caffeine. CONTENT: This review assesses the caffeine pharmacology, its action mechanisms, indications, contraindications, doses, interactions and adverse effects. CONCLUSIONS: There are insufficient double-blind randomized controlled studies that assess the analgesic effect of caffeine on several painful syndromes. Patients presenting chronic pain need caution when it comes to tolerance development, abstinence and drug interaction from chronic caffeine use.

JUSTIFICATIVA Y OBJETIVOS: La cafeína es una sustancia extensamente consumida que posee efectos en diversos sistemas y que presenta una farmacocinética y una farmacodinámica características, causando interacciones con diversos medicamentos. El objetivo de este estudio es hacer una revisión sobre los efectos de la cafeína. CONTENIDO: En esta revisión, abordamos la farmacología de la cafeína, los mecanismos de acción, las indicaciones, las contraindicaciones, las dosis, las interacciones y los efectos adversos. CONCLUSIONES: Faltan estudios controlados, randomizados y doble ciegos para evaluar la eficacia analgésica de la cafeína en los diversos síndromes dolorosos. En los pacientes con dolor crónico, se hace necesario un cuidado especial con relación al desarrollo de la tolerancia, abstinencia y de la interacción medicamentosa en el uso crónico de la cafeína.

Caffeine supplementation and muscle damage in soccer players / A suplementação de cafeína e lesão muscular em jogadores de futebol

The aim of this work was to evaluate the effect of caffeine supplementation and intermittent exercise on the muscle injury markers in soccer players. 15 male professional soccer players completed a placebo controlled double blind test protocol. 45 minutes before exercise, participants ingested 5.5 mg.kg-1 body mass of caffeine (EXP, n=8) or placebo (CONT, n=7). The exercise was 12 sets of 10 sprints (20 m each) with 10 sec recovery time between sprints and 2 min between sets. Blood samples were collected before (PRE) and 48h after exercise (POST). Serum activity of CK, LDH, AST, and ALT were quantified. Serum enzyme activity was enhanced by exercise in both groups, without a synergistic effect of caffeine. The findings suggest muscle injury markers concentration increases after physical activities, but caffeine supplementation (as used in this study) has no influence upon muscle cellular integrity.

O objetivo do trabalho foi avaliar o efeito da cafeína e do exercício intermitente nos marcadores de lesão muscular em jogadores de futebol. 15 jogadores de futebol profissional completaram um estudo duplo-cego placebo controlado. 45 minutos antes do exercício, os participantes ingeriram 5.5 mg.kg-1 do peso corporal de cafeína (EXP, n=8) ou placebo (CONT, n=7). O exercício consistiu em 12 séries de 10 sprints (com 20 m cada) com 10 segundos de recuperação entre os sprints e 2 min entre as séries. Amostras de sangue foram coletadas antes (PRE) e 48h depois do exercício (POST). As atividades séricas de CK, LDH, AST e ALT foram quantificadas. A atividade sérica de todas as enzimas aumentou em ambos os grupos, sem efeito sinérgico da suplementação de cafeína. Os achados confirmam que o exercício aumenta a atividade sérica das enzimas, mas a cafeína (como a usada neste estudo) não interfere na integridade da fibra muscular.

Acción in vitro de la cafeína en anillos de arteria mamaria interna utilizada en cirugía de revascularización cardiaca / In vitro effect of caffeine on internal mammary artery rings used in cardiac revascularization surgery

Introducción. El efecto vasodilatador de la cafeína en las arterias de modelos animales ya ha sido demostrado. Se desconocen estudios con la misma metodología in vitro utilizando arterias humanas. Objetivos. Evaluar los efectos vasoactivos in vitro de la cafeína en la arteria mamaria interna de humanos. Materiales y métodos. Se utilizaron 80 anillos de arteria mamaria interna (n=20 pacientes). La funcionalidad del endotelio se evaluó con acetilcolina a una concentración de 3,16x10 -6 M, de nitroglicerina con dosis acumulativas de 10 –11 M a 10 –4 M y de cafeína con concentraciones acumulativas de 10 –8 M a 10 –4 M. Resultados. La nitroglicerina indujo un porcentaje máximo de relajación de 87,4±12,3 por ciento, la cafeína, de 86,9±21,0 por ciento en arterias con endotelio funcional y de 71,6±28,6 por ciento en arterias con disfunción endotelial. No se encontraron diferencias entre los tres grupos ( p=0,289). Tampoco se encontraron diferencias en la EC 50 en arterias con endotelio funcional (1,66x10 -5 ±1,57x10 -5 M) y arterias disfuncionales (7,75x10 -5 ±14,64x10 -5 M). La nitroglicerina resultó más potente que la cafeína (EC 50 = 4,30x10 -9 ±4,35x10 -9 M) ( p=0,013). Conclusiones. Aunque la nitroglicerina fue un vasodilatador más potente, la cafeína tuvo un fuerte efecto vasodilatador arterial in vitro independientemente de la funcionalidad del endotelio en arterias humanas.

Sleep disorders, sleepiness and traffic safety: a public health menace

Sleep disorders are not uncommon and have been widely reported throughout the world. They have a profound impact on industrialized 24-h societies. Consequences of these problems include impaired social and recreational activities, increased human errors, loss of productivity, and elevated risk of accidents. Conditions such as acute and chronic insomnia, sleep loss, excessive sleepiness, shift-work, jet lag, narcolepsy, and sleep apnea warrant public health attention, since residual sleepiness during the day may affect performance of daily activities such as driving a car. Benzodiazepine hypnotics and zopiclone promote sleep, both having residual effects the following day including sleepiness and reduced alertness. In contrast, the non-benzodiazepine hypnotics zolpidem and zaleplon have no significant next-day residual effects when taken as recommended. Research on the effects of wakefulness-promoting drugs on driving ability is limited. Countermeasures for excessive daytime sleepiness have a limited effect. There is a need for a social awareness program to educate the public about the potential consequences of various sleep disorders such as narcolepsy, sleep apnea, shift-work-related sleep loss, and excessive daytime sleepiness in order to reduce the number of sleep-related traffic accidents.

Terapia neuroprotectora de la Enfermedad de Parkinson / Neuroprotective therapy in Parkinson's Disease

With the current limitations on treating Parkinsonãs disease, neuroprotection should be looked at as a possible way of slowing the varying processes involved in the onset of the disease. A review was made of the work of NINDS experts, who evaluated 59 drugs resulting from their Medline and Pub Med search. Twelve drugs, those considered the most promising, were included in the final analysis. We look at such substances as caffeine, coenzyme q10, estrogens, minocycline, nicotine, rasagiline-selegiline, and ropinirole-pramipexole. These agents acted dissimilarly, but favorably, on some of the diseaseãs processes or on its underlying pathogenesis, although the mechanisms involved and the duration of the beneficial effects were not clear. The challenge is to overcome the difficulties that make the results of the few current studies uncertain, using new methods, such as transgenic models, to maintain hope for effective future treatments.

Apnea in the newborn.

Apnea, defined as cessation of breathing resulting in pathological changes in heart rate and oxygen saturation, is a common occurrence in sick neonates. Apnea is a common manifestation of various etiologies in sick neonates. In preterm children it may be related to the immaturity of the central nervous system. Secondary causes of apnea should be excluded before a diagnosis of apnea of prematurity is made. Methylaxanthines and Continuous Positive Airway Pressure form the mainstay of treatment of apnea in neonates. Mechanical ventilation is reserved for apnea resistant to above therapy. An approach to the management of apnea in neonates has been described.

Avaliação clínica da eficácia da combinação paracetamol e cafeína no tratamento da cefaléia tipo tensão / Clinical evaluation of the efficacy of the paracetamol and caffeine combination in the treatment of tension headache

A cefaléia tipo tensão em suas duas modalidades, episódica e crônica, é a forma mais comum de dor de cabeça na população. O tratamento é feito com medidas não farmacológicas e farmacológicas, tanto para o ataque como profilaxia das crises. Este estudo foi realizado com 5490 pacientes, que procuraram ambulatórios e consultórios médicos em várias regiões do Brasil. Cerca de 95 por cento apresentavam cefaléia tipo tensão episódica e 5 por cento cefaléia tipo tensão crônica. A maioria dos pacientes apresentou crises de intensidade moderada (62,19 por cento). Em 5419 pacientes uma crise de cefaléia tipo tensão foi tratada com 1000 mg de paracetamol e 130 mg de cafeína. Em 93,98 por cento início de melhora foi observado em até 2 horas após a ingestão da medicação. Em 77,61 por cento houve reversão completa da crise em até 2 horas. Avaliação da eficácia boa/excelente foi observada em 51,93 por cento/37,80 por cento dos casos quando feita pelos médicos e em 48,51 por cento/40,29 quando pelos pacientes. Efeitos adversos, em geral manifestações gastrointestinais, foram observados em 5,57 por cento. Este estudo representa uma experiência brasileira no tratamento de ataque da cefaléia tipo tensão, demonstrando eficácia e segurança no uso da combinação paracetamol-cafeína.

Neuroprotection by caffeine and pentoxifylline during experimental cerebral ischaemia

Cerebral ischaemia was induced in anaesthetized rats by occlusion of the ipsilateral common carotid and middle cerebral arteries. The response to ischaemia was assessed by the reduction of the amplitude of recorded somatosensory evoked potentials (SSEPs), and the rate of recovery of the SSEPs during reperfusion. Caffeine and pentoxifylline when applied at 70 mM to the cortex for 60 min prior to induction of ischaemia significantly reduced the ischaemia induced attenuation of the SSEPs and hastened recovery to control levels. In contrast, application of normal saline or of the drugs for 15 min did not reduce the effect of ischaemia on the SSEPs. These results suggest that caffeine and pentoxifylline have potential roles in the management of patients with cerebral ischaemia.

G2 repair and chromosomal damage in lymphocytes from workers occupationally exposed to low-level ionizing radiation

The effect of the G2 repair of chromosomal damage in lymphocytes from workers exposed to low levels of X- or g-rays was evaluated. Samples of peripheral blood were collected from 15 radiation workers, 20 subjects working in radiodiagnostics, and 30 healthy control donors. Chromosomal aberrations (CA) were evaluated by scoring the presence of chromatid and isochromatid breaks, dicentric and ring chromosomes in lymphocytes with/without 5mM caffeine plus 3mM-aminobenzamide (3-AB) treatment during G2. Our results showed that the mean value of basal aberrations in lymphocytes from exposed workers was higher than in control cells (p< 0.001). The chromosomal damage in G2, detected with caffeine plus 3-AB treatment was higher than the basal damage (untreated conditions), both in control and exposed populations (p< 0.05). In the exposed workers group, the mean value of chromosomal abnormalities in G2 was higher than in the control (p< 0.0001). No correlation was found between the frequency of chromosome type of aberrations (basal or in G2), and the absorbed dose. Nevertheless, significant correlation coefficients (p< 0.05) between absorbed dose and basal aberrations yield (r = 0.430) or in G2 (r = 0.448) were detected when chromatid breaks were included in the total aberrations yield. Under this latter condition no significant effect of age, years of employment or smoking habit on the chromosomal aberrations yield was detected. However, analysis of the relationship between basal aberrations yield and the efficiency of G2 repair mechanisms, defined as the percentage of chromosomal lesions repaired in G2, showed a significant correlation coefficient (r = -0.802; p< 0.001). These results suggest that in addition to the absorbed dose, the individual G2 repair efficiency may be another important factor affecting the chromosomal aberrations yield detected in workers exposed to low-level ionizing radiation