Benefits of physical exercise on Parkinson's disease disorders induced in animal models

Aim: The preventive and therapeutic role of physical exercise in Parkinson's disease (PD) has been the target of study of many scientific groups, and the research often is done in experimental models, especially rodents. Thus, the aim of this review was to analyze a database, elucidating the main benefits that the systematized practice of physical activity/ exercises can contribute to PD in animal models. Method: Based on this question, a search on PubMed and Medline database containing the terms: "Parkinson's disease" AND "animal model" AND "physical exercise" was performed. The most pertinent studies were selected by the criteria year of publication (2009- 2018) and the original article. It was used papers involving animal models and physical exercises, as well as other studies, which allowed an introductory explanation in PD, covering its pathophysiology, and the neurochemical responses of physical exercise in rodents. Results: The results showed that there was a decrease in the levels of nigrostriatal neurodegeneration and an increase in the neuroprotective effect related to the training program. Conclusion: It was concluded that physical exercise has been pointed as an important neuroprotective strategy in animal models of Parkinson's disease, especially those applied at moderate intensities, which were effective in reducing the inflammatory profile, elevating the expression of genes and proteins related to neuronal restoration, mitochondrial biogenesis, repair of the dopaminergic system, besides other events also capable of reflecting improvements in motor and cognitive behavior of animals.(AU)

Arritmias cardíacas na sala de emergência e UTI. Bradicardias: como identificar e tratar o paciente com baixa perfusão / Cardiac arrhythmias in the emergency room and ICU. Bradyarrhythmias: how to identify and treat the patient with low perfusion

O sistema cardiovascular é responsável pelo fluxo circulatório adequado, o qual depende do volume sistólico e frequência cardíaca (FC). Quando insuficientes, causa hipofluxo cerebral e incapacidade de realizar atividades. A bradicardia é causada por: a) disfunção sinusal, manifestada por FC inapropriadas, pausas ou síndrome de taqui-bradicardia, síncopes, tonturas e intolerância aos esforços, sem risco à vida; b) distúrbio da condução atrioventricular (bloqueios atrioventriculares - BAV): de primeiro, segundo (Mobitz I, Mobitz II e avançado) e terceiro grau (Total) . O BAV de primeiro grau e do tipo Mobitz I tem bom prognóstico. O BAV Mobitz II, avançado e total, mesmo oligossintomático ou transitório, sem causas removíveis, tem maior morbimortalidade; c) distúrbios neuromediados e a síncope reflexa são desencadeados por posição ortostática ou exposição à estresse emocional e a síndrome do seio carotídeo associada à estimulação da carótida. A FC baixa pode estar associada a um maior risco, sendo que os sinais e sintomas indicam gravidade. Na urgência, deve-se tratar as causas subjacentes assegurar o bom funcionamento das vias aéreas administrar O2 monitorar ritmo, FC, pressão arterial, e, também, o acesso venoso. É importante analisar o ritmo, exame físico e histórico, além de pesquisar e tratar os fatores contribuintes. Caso haja sinais de baixa perfusão, deve-se administrar atropina. A estimulação por marcapasso transcutâneo é indicada, caso a atropina seja ineficaz. Além disso, deve-se considerar a adrenalina ou dopamina e estimulação transvenosa

The cardiovascular system is responsible for adequate circulatory flow, which depends on systolic volume and heart rate (HR). When insufficient, it causes cerebral hypoflow and inability to perform activities. Bradycardia is caused by: a) sinus dysfunction, manifested by inappropriate HR, pauses or tachycardia-bradycardia syndrome, syncope, dizziness and intolerance to exertion, without risk to life; b) atrioventricular conduction disorder (atrioventricular (AV) blocks): first, second (Mobitz type I, Mobitz type II and advanced) and third degree (complete). First-degree and Mobitz type I AV block both have good prognosis. Mobitz type II, advanced and complete AV block, even oligosymptomatic or transient, without removable causes, have higher morbidity and mortality; c) neuromediated disorders and reflex syncope are triggered by orthostatic position or exposure to emotional stress and carotid sinus syndrome, associated with carotid stimulation. Low HR may be associated with increased risk, and signs and symptoms indicate severity. In emergency conditions the underlying causes should be treated to ensure good functioning of the airways; administer O2; monitor cardiac rhythm, HR, blood pressure, and venous access. It is important to analyze rhythm, and conduct a physical examination and clinical history, and to check for and treat contributing factors. If there are signs of low perfusion, atropine should be administered. Simulation by transcutaneous pacemaker is indicated if atropine is ineffective. Epinephrine or dopamine and transvenous stimulation should also be considered

Cuidados pós-ressuscitação-cardiopulmonar (RCP) / Post-cardiopulmonary resuscitation (CPR) care

Evitar novos episódios de parada cardiorrespiratória (PCR). Identificar e tratar as causas que levaram o paciente à PCR. Oferecer suportes ventilatório, hemodinâmico, neurológico e metabólico. Realizar a modulação terapêutica de temperatura para todos os pacientes que retornaram à circulação espontânea. Indicação de cateterismo cardíaco para pacientes sem causa estabelecida de PCR quando a causa pode ser um evento coronariano

Avoid further episodes of cardiopulmonary arrest (CPA). Identify and treat the causes of the patient's CPA. Provide ventilatory, hemodynamic, neurological and metabolic support. Perform therapeutic temperature modulation for all patients who have resumed spontaneous circulation. Indication of cardiac catheterization for patients with no established cause of CPA when the cause may be a coronary event

Influence of Body Mass Index on the Growth Hormone Response to Provocative Testing in Short Children without Growth Hormone Deficiency

Obesity and its related factors are known to suppress the secretion of growth hormone (GH). We aimed to evaluate the influence of body mass index (BMI) on the peak GH response to provocative testing in short children without GH deficiency. We conducted a retrospective review of medical records of 88 children (2-15 yr old) whose height was less than 3 percentile for one's age and sex, with normal results (peak GH level > 10 ng/mL) of GH provocative testing with clonidine and dopamine. Peak stimulated GH level, height, weight, pubertal status and serum IGF-1 level were measured. Univariate analysis showed that the BMI standard deviation score (SDS) correlated negatively with the natural log (ln) of the peak stimulated GH level (ln peak GH). BMI SDS did not correlate significantly with sex, age, pubertal status, or ln IGF-1 level. BMI SDS correlated negatively with ln peak GH level induced by clonidine but not by dopamine. In stepwise multivariate regression analysis, BMI SDS was the only significant predictor of ln peak GH level in the combination of tests and the clonidine test, but not in the dopamine test. In children without GH deficiency, BMI SDS correlates negatively with the peak GH level. BMI SDS should be included in the analysis of the results of GH provocation tests, especially tests with clonidine.

Drogas vasopressoras nos estados choque: qual é a melhor opção? / Vasopressors drugs in the shock state: which is the best option?

JUSTIFICATIVA E OBJETIVOS: Apesar da terapia com fármacos vasopressores ser usada há décadas, poucos ensaios clínicos comparam os diferentes tipos utilizados nos diferentes tipos de choque. O objetivo deste estudo foi rever os principais estudos publicados, nas ultimas décadas, para orientação quanto à escolha da melhor droga vasopressora nos diferentes estados de choque. CONTEÚDO: Foram selecionados artigos na base de dados MedLine (1950-2008), por meio das palavras-chave: drogas vasoativas, drogas vasopressoras e choque. Adicionalmente, referências desses artigos, capítulos de livros e artigos históricos foram avaliados para esta revisão. Foram identificados e revisados 160 artigos. Foram considerados ensaios clínicos da língua inglesa, estudos retrospectivos e artigos de revisão. Os artigos foram avaliados por análise de método e determinação de limitações de desenho. Por não se tratar de uma metanálise, mas sim de uma revisão descritiva, serão apresentadas as conclusões mais relevantes dos principais estudos e metanálises encontrados nessa revisão, sem a interferência direta da análise pessoal dos autores deste estudo. CONCLUSÕES: O uso de drogas vasopressoras nos estados de choque permanece controverso. A escolha de uma droga específica para determinado tipo de choque permanece aberta. Existem várias drogas vasopressoras que podem ser utilizadas, inclusive em combinação na terapêutica dos pacientes em estado de choque. Estudos clínicos aleatórios têm sido realizados na tentativa de aperfeiçoar a evidência do uso de drogas vasoativas. Esta permanece ainda uma questão sem sólidas e robustas respostas baseadas em evidências. Descritores: drogas vasopressoras, estado de choque.(AU)

BACKGROUND AND OBJECTIVES: Despite treatment with drugs vasopressors are used for decades, few clinical trials comparing the different types and drugs used in different types of shock. This study aimed at reviewing the major articles published, in recent decades, for guidance on choosing the best vasopressor drugs in different state of shock. CONTENTS: Were selected articles in the database Med- Line (1950-2008), using the keywords: vasoactive drugs, drugs vasopressors and shock. Additionally, references of these articles, chapters of books and historical articles were evaluated for this review. Were identified and reviewed 160 articles. We considered clinical trials of English, retrospective studies and reviews. The articles were evaluated by analysis of method and determination of limitations of design. It is not a meta-analysis, but a descriptive review, will be presenting the findings most relevant of the major studies and meta from this review, without the interference of direct personal analysis of the authors of this study. CONCLUSION: The use of drugs vasopressors in the states of shock remains controversial. The choice of a drug specifically for a particular type of shock remains open. There are several drugs vasopressors that can be used, even in combination in therapeutic for patients in shock. Randomized clinical trials have been conducted in an attempt to optimize the evidence of the use of vasoactive drugs. This still remains an issue without solid and robust response based on evidence.(AU)

Insuficiência cardíaca descompensada na unidade de emergência de hospital especializado em cardiologia / Decompensated heart failure in the emergency department of a cardiology hospital

FUNDAMENTO: Estudos nacionais em insuficiência cardíaca descompensada (ICD) são fundamentais para o entendimento dessa afecção em nosso meio. OBJETIVO: Determinar as características dos pacientes com ICD em uma unidade de emergência. MÉTODOS: Examinamos prospectivamente 212 pacientes com o diagnóstico de insuficiência cardíaca descompensada, os quais foram admitidos em uma unidade de emergência (UE) de hospital especializado em cardiologia. Estudaram-se variáveis clínicas, apresentação e causas de descompensação. Em 100 pacientes, foram analisados exames complementares, prescrição de drogas vasoativas, tempo de internação e letalidade. RESULTADOS: Entre os pesquisados houve predomínio de homens (56 por cento) e a etiologia isquêmica foi a mais freqüente (29,7 por cento), apesar da elevada freqüência de valvares (15 por cento) e chagásicos (14,7 por cento). A forma de apresentação e a causa de descompensação mais comuns foram, respectivamente, congestão (80,7 por cento) e má adesão/medicação inadequada (43,4 por cento). Na subanálise dos 100 pacientes, a disfunção sistólica foi a mais freqüente (55 por cento), uso de drogas vasoativas ocorreu em 20 por cento e a letalidade foi de 10 por cento. Análise comparativa entre os pacientes que receberam alta e faleceram durante a internação ratificou alguns critérios de mau prognóstico: pressão arterial sistólica reduzida, baixo débito associado à congestão, necessidade de droga vasoativa, fração de ejeção do ventrículo esquerdo reduzida, diâmetro diastólico do ventrículo esquerdo (DDVE) aumentado e hiponatremia. CONCLUSÃO: Este trabalho apresenta dados sobre o perfil da população com insuficiência cardíaca descompensada atendida na unidade de emergência de um hospital especializado em cardiologia da região sudeste do Brasil. Na avaliação inicial destes pacientes dados clínico-hemodinâmicos e de exames complementares fornecem subsídios para estratificação de risco, auxiliando na decisão de internação...

BACKGROUND: National studies on decompensated heart failure (DHF) are key to the understanding of this condition in our midst. OBJECTIVE: To determine the characteristics of DHF patients in an emergency department. METHODS: A total of 212 patients diagnosed with decompensated heart failure who had been admitted to an emergency department (EU) of a cardiology hospital were prospectively evaluated. Clinical variables, form of presentation and causes of decompensation were studied. In 100 patients, ancillary tests, prescription of vasoactive drugs, length of hospital stay and mortality were also analyzed. RESULTS: There was a predominance of the male gender (56 percent) and the most frequent etiology was ischemia (29,7 percent) despite high frequency of valvular (15 percent) and chagasic (14,7 percent) etiologies. The most common form of presentation and cause of decompensation were congestion (80.7 percent) and poor compliance/inadequate medication (43.4 percent), respectively. In the subanalysis of the 100 patients, systolic dysfunction was the most common cause of decompensation (55 percent); use of vasoactive drugs occurred in 20 percent, and mortality was 10 percent. The comparative analysis between the patients who were discharged and those who died during hospitalization confirmed some criteria of poor prognosis: reduced systolic blood pressure, low cardiac output associated with congestion, need for vasoactive drugs, reduced left ventricular ejection fraction, increased left ventricular diastolic diameter (LVDD) and hyponatremia. CONCLUSION: This study presents information about the profile of decompensated heart failure patients attended on the emergency unit of a brazilian southeast cardiology hospital. Clinical, hemodynamical and ancillary data may provide information for risk assessment in the initial evaluation helping the decision on hospitalization and advanced strategic therapies.

Hypotension in preterm infants.

PURPOSE: Hypotension is a frequent occurrence in sick preterm neonates. It is important to appropriately recognise and treat hypotension in preterm infants due to the possible association with short and long term adverse outcomes. SEARCH STRATEGY: An extensive search for relevant articles was carried out on PubMed, Embase and Cochrane database of systematic reviews. Cross references were hand searched. CONCLUSIONS: The pathophysiology hypotension in preterm infants is multifactorial. Hypovolemia plays only a minor role in the absence of overt fluid losses. Cardiac dysfunction seems to be a factor in some neonates. Assessment of hypotension should be based on an overall clinical condition. Overzealous fluid administration seems to be associated with adverse outcomes and should be avoided in the absence of obvious fluid losses. Inotropes should be used if fluid boluses fail to correct hypotension. Dopamine is the most effective inotrope. Dobutamine can be used as add on therapy or as first line if cardiac dysfunction is an obvious cause. Evidence points to hypocortisolism in at least some hypotensive infants. Steroids have been used successfully in inotrope-resistant hypotension in some infants. Steroids should be used judiciously since there have been concerns about adverse neurological outcome in preterm infants who received steroids in the neonatal period.

Staphylococcal toxic shock syndrome.

A 28 year old male presented with fever, tachycardia, generalized lymphadenopathy and diffuse rash over the body. He failed to respond to intravenous antibiotics and developed cardiogenic shock, multiple organ failure and died within six hours after hospitalization. Staphylococcus aureus colonies were revealed on blood culture.

Efeitos do óxido nítrico inalatório na hipertensão pulmonar de pacientes após cirurgia valvar mitral / Effects of inhaled nitric oxide on pulmonary hypertension in patients after mitral valve surgery

OBJETIVO: O estudo consiste em verificar os efeitos da utilização do óxido nítrico inalatório (NOi) em pacientes no pós-operatório de cirurgia valvar mitral. MÉTODO: Os efeitos do NOi foram medidos principalmente por meio da verificação de alterações na pressão arterial pulmonar (PAP). Outras medidas realizadas incluíram: pressão arterial média (PAM), pressão venosa central média (PVC), pressão média de átrio esquerdo (PAE), saturação de oxigênio por oximetria de pulso, complacência pulmonar estática e gradiente transpulmonar (GTP). RESULTADOS: Nos 20 pacientes estudados, obteve-se tempo mediano de utilização do NOi de 19,1 horas. A PAP média reduziu significativamente de 33,8 ± 6,17 mmHg (pré-NOi) para 29,1 ± 6,46 mmHg, nos 30 minutos iniciais e para 28,4 ± 5,22 mmHg, considerando a média de todas as medidas pós-NOi (p< 0,05). O GTP também apresentou redução estatisticamente significativa. Não houve alterações significativas nas demais medidas hemodinâmicas. CONCLUSÃO: Os achados indicam que a utilização do NOi reduz a PAP sem efeitos sistêmicos, demonstrando efeito vasodilatador seletivo no sistema vascular pulmonar.

OBJECTIVE: Cardiac surgery in patients with pulmonary hypertension may present severe postoperative complications. The study consists of verifying the effects of using inhaled nitric oxide (iNO) in patients during the postoperative period of mitral valve surgery. METHODS: The effects of iNO were measured mainly by verifying changes in pulmonary artery pressure (PAP). Other measures performed included mean arterial pressure (MAP), mean central venous pressure (CVP), mean left atrial pressure (LAP), oxygen saturation by pulse oxymetry, and static pulmonary compliance. RESULTS: In the 20 patients studied, a median time of iNO use of 19.1 hours was obtained. The mean PAP was significantly reduced from 33.8 ± 6.17 mmHg (pre-iNO) to 29.1 ± 6.46 mmHg in the initial 30 minutes and to 28.4 ± 5.22 mmHg considering the mean of all post-iNO measures (p< 0.05). No significant changes occurred in the other hemodynamic measures. CONCLUSION: The findings indicate that the use of iNO, in post-operative period of mitral valve operation associated with pulmonary hypertension, reduces PAP without systemic effects, demonstrating a selective vasodilator effect on the pulmonary vascular system.

Modulación dopaminergica mediana por receptores DA1, en tráquea aislada de rata / Modulation dopaminergica mediated by receiving DA1, in isolated windpipe of rat

En trabajos previos hemos demostrado, que la administración de dopamina a bajas dosis por vía inhalatoria (0.5-2 µg/ml/min) produce dilatación bronquial en pacientes con ataques agudos de asma y planteamos que la dilatación observada es posiblemente mediada por receptores dopaminérgicos y no por receptores de tipo adrenérgico. Estudiar el posible efecto modulador de la dopamina sobre el músculo liso de tráquea aislada de rata y examinar el efecto de los antagonistas a y ß2 adrenérgicos y de los antagonistas dopaminérgicos DA1 y DA2, sobre la actividad dopaminérgica en tráquea aislada de ratas Sprague Dawley. Métodos. Anillos de tráquea de ratas Sprague Dawley de 200 a 400 gramos de peso, fueron escindidos y colocados en un baño de órgano aislado con solución Krebs a 37ºC, Oxígeno 95 por ciento y CO2 5 por ciento. Las contracciones fueron registradas con un transductor isométrico y un polígrafo (Letica) e inducidas añadiendo dosis acumulativas de acetilcolina al baño (1, 3, 6 µM seguidas de curvas acumulativas, de dopamina (1, 3, 10 µM). Cada antagonista se incubó por 15 min y se repitieron las curvas con acetilcolina y con dopamina. La dopamina inhibió la contracción inducida por estimulación de campo eléctrico y por los agentes farmacológicos acetilcolina y carbaminoilcolina. Sobre la contracción con acetilcolina la dopamina a dosis de 1 y 3 µM produjo inicialmente un pequeño aumento de la contracción, seguida de una dilatación de mayor magnitud; la adición de dopamina 10 µM revirtió totalmente la contracción. Las dos fases de la dopamina no fueron bloqueadas por propranolol (0.1 µM), ni por los antagonistas a adrenérgicos terasozin (0.1µM) ni yohimbina (0.1 µM). El antagonista DA2, metoclopramida (1, 2, 4, 8 µM) produjo un efecto potenciador colinérgico, pero no bloqueó las dos fases de la dopamina. La incubación con el antagonista DA1, SCH23390 (0.1 µM) produjo una contracción inmediata, sostenida, por mas de 15 min. y produjo un bloqueo parcial.

Depressão miocárdica na sepse / Myocardial depression in sepsis

A disfunção miocárdica é um evento reconhecido na sepse e no choque séptico há muitos anos. Diversos mecanismos foram propostos, como a isquemia global do músculo cardíaco e a liberação de mediadores inflamatórios com propriedades depressoras miocárdicas pelos macrófagos tissulares. O mecanismo de ação destes mediadores também foi extensamente estudado, sugerindo serem o óxido nítrico e a esfingosina os efetores da disfunção mediada pelo TNF-a e pela IL-1B. O tratamento específico da disfunção miocárdica na sepse e no choque séptico ainda não foi encontrado, porém sabe-se que a mesma é reversível após o controle da doença de base

The myocardial dysfunction is a well known event in sepsis and septic shock. Many mechanisms were proposed such as global ischemia of the cardiac muscle and the inflammatory mediators production leading to myocardial depression. The mechanism of action of these mediators has also been studied. Nitric oxide and esfingosin are possible effectors of the dysfunction that is mediated by TNF-a and IL-1B. The specific treatment of the myocardial dysfunction in sepsis and septic shock has not been defined. The heart function improves after the control of the disease

Síndrome de déficit atencional: antecedentes neurobiológicos y cognitivos para estudiar un modelo de endofenotipo / Attention deficit and hyperactivy disorder: neurobiological issue towards a cognitive endophenotype model

Este artículo es una breve actualización en cuanto a las bases cognitivas del Síndrome de Déficit Atencional e Hiperactividad (SDAH). Presentamos algunos resultados recientes en que analizamos estrategias cognitivas y el efecto neurofisiológico de psicoestimulantes en esta condición. Esbozamos un modelo basado en resultados nuestros y de otros grupos, en el cual la estrategia atencional de los sujetos con SDAH se caracteriza por un amplio marco espacial y una corta ventana temporal en comparación a los controles. Por último, proponemos líneas de investigación básico-clínica respecto de éste síndrome.

This article is a brief update on the cognitive bases of Attention Deficit and Hyperactivity Disorder (ADHD). We show some of our recent results in which we analyze cognitive strategies and neurophysiological effect of psychostimulants in this disorder. We summarize a model, based on our own results and those of other laboratories, in which the attention strategy of ADHD subjects is characterized by a wide spatial frame but a narrow time window compared to controls. Finally, we suggest lines of basic-clinical research for this syndrome.

La verdad de la dosis renal de dopamina / The truth about the renal dose of dopamine

La dopamina se ha utilizado para prevenir y tratar la falla renal aguda. Ejerce su efecto dependiendo de la dosis que se administre por vía endovenosa, siendo la dosis renal de 3 µg / kg / min. Sus efectos sobre el riñón son mediados por la estimulación de los receptores dopaminérgicos, donde el más importante es la vasodilatación de la arteriola aferente. Se postula, además, que actuaría como una hormona natriurética intrarrenal debido a cambios en el túbulo distal.Existen estudios a favor del uso de la dosis renal de dopamina que han demostrado un aumento de la diuresis o el inicio de ésta en pacientes con falla renal aguda. Sin embargo, estos estudios son no controlados, con un número pequeño de pacientes y en los cuales no se han considerado los efectos adversos de esta droga, por lo tanto, sin significancia estadística. Nuevos estudios controlados, randomizados, doble ciego y estadísticamente significativos, han demostrado que los beneficios de la dopamina son escasos o nulos comparados con un placebo, incluso su uso perjudicaría aún más la función renal y la sobrevida de los pacientes. El por qué se sigue utilizando en la práctica clínica y qué otras alternativasexisten para prevenir y tratar la falla renal aguda, formarán parte de la discusión de este trabajo.

Prevention of postoperative acute renal failure.

Postoperative acute renal failure (PO-ARF) is a serious complication resulting in a prolonged stay and high mortality. Patients may be at risk for this problem because of an underlying medical illness, nature of surgery, nephrotoxin exposure, or combinations of these factors. An increase in the intra abdominal pressure above 20-mm Hg is associated with an increase in the incidence of PO-ARF. Based on many clinical studies in high-risk surgical patients and patients undergoing renal transplantation, the only proven management strategies for prevention of PO-ARF are adequate volume expansion and avoidance of hypovolaemia. Drugs known to be nephrotoxic should be avoided or used with caution. Three main pharmacological agents namely mannitol, frusemide and dopamine have been extensively tried in the prevention of PO-ARF. Mannitol has proven of value only in the presence of adequate volume expansion in attenuating renal dysfunction in transplant patients. Frusemide converts oliguric renal failure to non-oliguric renal failure. The bulk of the data, including that from prospective studies indicate dopamine is only a diuretic. Fenoldopam, a dopamine analogue, has shown early promise in reports. Calcium channel blockers have not been shown to improve the outcome in renal transplantation or help in the prevention of contrast-induced nephropathy. Atrial natriuretic peptide has not been proven to be of benefit in established renal failure and its role in prevention has not been assessed.

Postoperative hypertensive-hypervolaemic-haemodilution (Triple H) therapy in the treatment of vasospasm following aneurysmal subarachnoid haemorrhage.

Twenty five patients with post operative ischaemic deficits, following clipping of intracranial aneurysms, were studied. Hypertensive-hypervolaemic-haemodilution (triple H) therapy was given to all patients using colloids and crystalloids. CVP was used to monitor the fluid therapy. Dopamine was needed in 22 patients to elevate the systemic blood pressure. Vasospasm was confirmed in 20 patients with transcranial doppler studies (TCD). 20 (80%) patients survived, 10 (40%) with good outcome, 7 (28%) with fair, 2 (8%) with poor outcome and 1 (4%) with vegetative state. There were 5 (20%) deaths, 4 of which occurred due to infarct. All these patients had poor Hunt and Hess grade at admission, high Fisher grade haemorrhages in the initial CT scan and/or required prolonged temporary clipping at surgery. One death occurred due to central venous line induced septicaemia. The duration of 'triple H therapy' amongst the survivors varied from 2-7 days with an average of 4.6 days. The complications of 'triple H therapy' included hypokalaemia (3 patients), haemorrhagic infarct (1 patient) and septicaemia (1 patient). It is concluded that 'triple H therapy' is useful in treating vasospasm induced ischaemic deficits. It worsens brain oedema in presence of acute infarcts and hence is contraindicated in such patients. A further study involving a larger number of patients with strict haemodynamic and ICP monitoring is suggested to determine the usefulness of individual components of 'triple H therapy'.

Meningitis bacteriana aguda por streptococcus pyogenes: caso clínico y revisión de la literatura / Acute bacterial meningitis by streptococcus pyogenes: case report and literature review

Streptococcus pyogenes (sbhga) es un microorganismo reconocido por causar una gran variedad de patologías. Durante la última década se ha observado un incremento mundial tanto en la incidencia como en la gravedad de las infecciones provocadas por esta bacteria. El presente artículo reporta el caso de un lactante menor que ingresó al área de cuidados críticos del Hospital Padre Hurtado, cursando con shock séptico y meningitis secundaria a s. pyogenes, resultando en un desenlace fatal

Depressäo unipolar: uma revisäo / Unipolar depression: a review

A depressäo é uma doença grave e comum, associada com prejuízo do funcionamento social e ocupacional, e com alto custo econômico. Pesquisas e observaçöes clínicas têm demonstrado que pacientes com depressäo têm uma significativa probabilidade de apresentar recaída, recorrência, cronicidade e sintomas subsindrômicos residuais entre os episódios da doença. Apesar de sua gravidade, observou-se que muitos pacientes näo säo adequadamente diagnosticados e tratados na populaçäo geral. Até o momento, pouco se sabe sobre a patogênesee a fisiopatologia da depressäo. Assim como, nenhum marcador biológico apresenta sensibilidade, especificidade e valor preditivo para auxiliar o diagnóstico dos transtornos depressivos, prever sua evoluçäo, orientar a terapêutica e promover a seleçäo de pacientes. Existem questöes ainda näo resolvidas no tratamento da depressäo unipolar recorrente. A primeira diz respeito à duraçäo do tratamento. Atualmente, há uma tendência em se manter a dose de antidepressor usada na fase aguda. Aproximadamente, 20 a 30 por cento dos pacientes com transtorno depressivo maior näo têm uma resposta satisfatória ao tratamento com antidepressores. Esta "näo resposta" ao tratamento pode resultar de um erro diagnóstico, do tratamento inadequado, da coexistência de outras condiçöes médicas e psiquiátricas e/ou de fatores psicosociais complicadores