Sindrome de Atra / Atra syndrome

La leucemia promielocítica aguda (APL) es el subtipo de leucemia mieloide aguda de mejor pronóstico en niños. Su incidencia es menor a 10%. Desde el punto de vista citogenético se observa una translocación t (15;17). En la terapéutica la incorporación del ácido transretinoico ha logrado altas tasas de remisión completa debido a la rápida desaparición de la coagulopatía y, en consecuencia, disminución de la tasa de recaídas, en comparación con el tratamiento de monoterapia. En general es un fármaco bien tolerado pero puede tener reacciones adversas; el más grave es el síndrome de ácido transretinoico (ATRA), potencialmente mortal. Las manifestaciones clínicas son: fiebre, ganancia de peso, infiltrados pulmonares, síndrome de dificultad respiratoria, derrame pleural o pericárdico, hipotensión, insuficiencia hepática y renal. El tratamiento es con suspensión del ácido transretinoico, medidas de apoyo y altas dosis de esteroides. Se presenta un caso clínico del hospital del Niño DIF con APL y Síndrome de ATRA.

The leukemia promyelocytic acute (APL) is the subtype of leukemia myeloid acute of better prognosis in children. Its incidence is less than 10%. From the point of view cytogenetic is observed a translocation t (15; 17). The addition of the acid transretinoico has achieved high rates of complete remission because of the rapid disappearance of the coagulopathy and, consequently, decrease in the rate of relapses, compared with monotherapy treatment. In general it is a well-tolerated drug but can have adverse reactions; the most serious is transretinoico acid (ATRA), potentially fatal syndrome. The manifestations are: fever, weight gain, pulmonary infiltrates, syndrome of shortness of breath, hypotension, pleural effusion or pericardial, hepatic and renal insufficiency. The treatment is with suspension of the acid transretinoico, measures of support and high doses of steroids. It presents a case clinical of the Hospital del Niño DIF with APL and syndrome of ATRA.

Hypoxia/reoxygenation-induced myocardial lesions in newborn piglets are related to interindividual variability and not to oxygen concentration

OBJECTIVE: Evaluation of myocardial histological changes in an experimental animal model of neonatal hypoxiareoxygenation. METHODS: Normocapnic hypoxia was induced in 40 male Landrace/Large White piglets. Reoxygenation was initiated when the animals developed bradycardia (HR <60 beats/min) or severe hypotension (MAP <15 mmHg). The animals were divided into four groups based on the oxygen (O2) concentration used for reoxygenation; groups 1, 2, 3, and 4 received 18%, 21%, 40%, and 100% O2, respectively. The animals were further classified into five groups based on the time required for reoxygenation: A: fast recovery (<15 min); B: medium recovery (15-45 min); C: slow recovery (45-90 min); D: very slow recovery (>90 min), and E: nine deceased piglets. RESULTS: Histology revealed changes in all heart specimens. Interstitial edema, a wavy arrangement, hypereosinophilia and coagulative necrosis of cardiomyocytes were observed frequently. No differences in the incidence of changes were observed among groups 1-4, whereas marked differences regarding the frequency and the degree of changes were found among groups A-E. Coagulative necrosis was correlated with increased recovery time: this condition was detected post-asphyxia in 14%, 57%, and 100% of piglets with fast, medium, and slow or very slow recovery rates, respectively. CONCLUSIONS: The significant myocardial histological changes observed suggest that this experimental model might be a reliable model for investigating human neonatal cardiac hypoxia-related injury. No correlation was observed between the severity of histological changes and the fiO2 used during reoxygenation. Severe myocardial changes correlated strictly with recovery time, suggesting an unreported individual susceptibility of myocardiocytes to hypoxia, possibly leading to death after the typical time-sequence of events.

Melatonin Protects the Heart, Lungs and Kidneys from Oxidative Stress under Intermittent Hypobaric Hypoxia in Rats

Melatonin (N-acetyl-5-methoxytryptamine) is the main secretory product of the pineal gland in all mammals including humans, but it is also produced in other organs. It has been previously demonstrated to be a powerful organ-protective substance under oxidative stress conditions. The aim of this study was to evaluate the protective effect of melatonin in several organs such as heart, lung, kidney, and of the reproductive system, such as testis and epididymis in animals exposed to intermittent hypobaric hypoxia and therefore exposed to oxidative stress and analyzed by lipid peroxidation. Ten-week-old male Wistar rats were divided into 6 groups for 96 hours during 32 days under: 1) Normobaric conditions, 2) plus physiologic solution, 3) plus melatonin, 4) intermittent hypobaric hypoxia, 5 plus physiologic solution and 6) plus melatonin. The animals were injected with melatonin (10 mg/kg body weight) at an interval of 96 hours during 32 days. Results indicated that melatonin decreased lipid peroxidation in heart, kidneys and lung under intermittent hypobaric hypoxia conditions. However, it did not exhibit any protective effect in liver, testis, epididymis and sperm count.

Anticonvulsant activity of bacopa monniera in rodents / Anticonvulsivante atividade de bacopa monniera em roedores

Bacopa monnieri (L), belonging to the Scrophulariaceae family and commonly known as Brahmi, is well known in India for its CNS activity but its neuropharmacological effect has not yet been explored. In the present study, the antiepileptic effects of the plant were investigated. The ethanolic extract of Bacopa monniera was tested for anticonvulsant activity in albino rats, using different convulsive models. The ethanolic extract of leaves produced significant anticonvulsant activity for all the different models studied. The present study shows a probable mechanism of action similar to that of benzodiazepines (GABA agonist). Thus, these results emphasize the need to diversify by using alternative therapeutic approaches pertaining to herbal medicine, where a single easily available plant may provide solutions to several therapeutic challenges, as observed in the anticonvulsant action of ethanolic extract of B. monniera.

Bacopa monniera, da família Scrophulariaceae, e comumente denominada Brahmi, é bem conhecida na Índia por sua atividade no Sistema Nervoso Central, mas seu efeito neurofarmacológico não foi, ainda, explorado. No presente estudo, investigaram-se os efeitos antiepilépticos da planta. O extrato etanólico da Bacopa monniera foi testado quanto à atividade anticonvulsivante em ratos albinos, utilizando-se diferentes modelos de convulsão. O extrato etanólico das folhas produziu atividade anticonvulsivante significativa para todos os diferentes modelos estudados. O presente estudo mostra provável mecanismo de ação semelhante ao dos benzodiazepínicos (agonista do GABA). Assim sendo, esses resultados enfatizam a necessidade de diversificar, utilizando-se abordagens terapêuticas alternativas da medicina natural, em que uma planta facilmente disponível pode fornecer soluções para vários desafios terapêuticos, como o observado na ação anticonvulsivante do extrato etanólico de Bacopa monniera.

Segurança da ecocardiografia transesofágica em adultos: Estudo em um hospital multidisciplinar / Safety of transesophageal echocardiography in adults: study in a multidisciplinary hospital / Seguridad de la ecocardiografía transesofágica en adultos: Estudio en un hospital multidisciplinario

FUNDAMENTO: A ecocardiografia transesofágica (ETE) é um exame semi-invasivo amplamente utilizado e seu uso associado a sedativos poderá influenciar a segurança do procedimento. OBJETIVO: analisar aspectos da segurança da ETE associada ao uso de midazolam (MZ) e flumazenil (FL) e a influência de variáveis clínicas na taxa de eventos. MÉTODO: estudo prospectivo com 137 pacientes que realizaram ETE com MZ associado à sedação moderada. Analisamos as seguintes ocorrências: complicações com anestesia tópica, ao uso do MZ e complicações relacionadas ao procedimento. Análises uni e multivariada foram usadas para testar a influência das variáveis clínicas: idade, sexo, acidente vascular cerebral (AVC), miocardiopatia (MP), duração do exame, insuficiência mitral (IM) e dose de MZ. RESULTADOS: todos pacientes (65±16 anos; 58 por cento masculino) completaram o exame. As doses médias de MZ e FL foram de 4,3±1,9 mg e 0,28±0,2 mg, respectivamente. A duração do exame e a fração de ejeção (FE) média foram de 16.4±6.1 minutos e 60±9 por cento, respectivamente. O evento mais comum foi a hipóxia leve (SO2<90 por cento), em 11 pacientes; 3 pacientes (2 por cento) apresentaram hipóxia transitória por obstrução da via aérea superior na passagem da sonda, enquanto 8 (5,8 por cento) apresentaram hipóxia devido ao uso do MZ. Hipotensão transitória (PAS<90 mmHg) ocorreu em 1 paciente (0,7 por cento). A análise multivariada mostrou que insuficiência mitral (IM) importante, MP (FE<45 por cento) e altas doses do MZ (>5mg) tiveram associação com tais eventos (p<0,001). A FE no grupo com MP foi de 40 por cento, ao passo que, no grupo com insuficiência mitral (IM), esse percentual foi de 44 por cento, podendo ser este um fator associado a eventos clínicos neste último grupo. CONCLUSÃO: ETE com sedação tem baixas taxas de eventos. Não se observou eventos graves e não houve a necessidade de interrupção dos exames.

BACKGROUND: TEE is a semi-invasive tool broadly used and its utilization associated to sedatives drugs might to affect the procedure safety. OBJECTIVE: to analyze aspects of TEE safety associated to the use of Midazolan (MZ) and Flumazenil (FL) and the influence of the clinical variables on the event rate. METHOD: prospective study with 137 patients that underwent TEE with MZ associated to moderate sedation. We analyzed the following events: complications related with the topical anesthesia, with MZ use and with the procedure. Uni- and multivariate analyses were used to test the influence of the clinical variables: age, sex, stroke, myocardiopathy (MP), duration of the test, mitral regurgitation (MR) and the MZ dose. RESULTS: All patients (65±16 yrs; 58 percent males) finished the examination. The mean doses of MZ and FL were 4.3±1.9 mg and 0.28±0.2 mg, respectively. The duration of the examination and the mean ejection fraction (EF) were 16.4±6.1 minutes and 60±9 percent, respectively. Mild hypoxia (SO2<90 percent) was the most common event (11 patients); 3 patients (2 percent) presented transient hypoxia due to upper airway obstruction by probe introduction and 8 (5.8 percent) due to hypoxia caused by MZ use. Transient hypotension (SAP<90mmHg) occurred in 1 patient (0.7 percent). The multivariate analysis showed that severe MR, MP (EF<45 percent) and high doses of MZ (>5mg) were associated with events (p<0.001). The EF was 40 percent, in the group with MP and 44 percent in the group with severe MR and it can be a factor associated with clinical events in the last group. CONCLUSION: TEE with sedation presents a low rate of events. There were no severe events and there was no need to interrupt the examinations.

FUNDAMENTO: La ecocardiografía transesofágica (ETE) es un examen semiinvasivo ampliamente utilizado y su uso asociado a sedantes puede influir sobre la seguridad del procedimiento. OBJETIVO: Analizar aspectos de la seguridad de la ETE asociada al uso de midazolam (MZ) y flumazenil (FL) y la influencia de variables clínicas en la tasa de complicaciones. MÉTODO: Estudio prospectivo con 137 pacientes, a quienes se realizó ETE con MZ asociado a la sedación moderada. Analizamos los siguientes eventos: complicaciones con anestesia local, relacionadas al uso de MZ y complicaciones relacionadas con el procedimiento. Se utilizaron análisis uni y multivariados para evaluar la influencia de las variables clínicas: edad, sexo, accidente cerebrovascular (ACV), miocardiopatía (MP), duración del estudio, insuficiencia mitral (IM) y dosis de MZ. RESULTADOS: Todos los pacientes (65±16 años; 58 por ciento masculino) completaron el estudio. Las dosis promedio de MZ y FL fueron de 4,3±1,9 mg y 0,28±0,2 mg, respectivamente. La duración del estudio y la fracción de eyección (FE) promedio fueron de 16.4±6.1 minutos y 60±9 por ciento, respectivamente. El evento más común fue la hipoxia leve (SO2<90 por ciento), en 11 pacientes; 3 pacientes (2 por ciento) presentaron hipoxia transitoria por obstrucción de la vía aérea superior con el pasaje de la sonda, mientras que 8 (5,8 por ciento) presentaron hipoxia debido a la utilización del MZ. Un paciente (0.7 por ciento) padeció hipotensión transitoria (PAS<90 mmHg). El análisis multivariado mostró que IM significativa, MP (FE<45 por ciento) y altas dosis de MZ (>5mg) se asociaron a tales complicaciones (p<0,001). La FE en el grupo con MP fue de 40 por ciento, mientras que, en el grupo con insuficiencia mitral, ese porcentaje fue de 44 por ciento, pudiendo ser éste un factor asociado a complicaciones clínicas en este último grupo. CONCLUSIÓN: ETE con sedación presenta bajas tasas de ...

Predictors of outcome in children with hydrocarbon poisoning receiving intensive care.

The retrospective study included 48 children between 8.5 months--10 years, admitted to the PICU of an urban, tertiary care, teaching hospital in northern India from January 1995 to December 2001. Eighteen (38%) patients were hypoxemic on arrival, of which 8 (45%) required mechanical ventilation. Compared to the non-hypoxemic children, the hypoxemic patients were more likely to have received gastric lavage before arrival to our center (Odds Ratio 23.2, 95% CI 2.4 - 560.7) and had higher frequency of severe respiratory distress and leucocytosis (Odds Ratio 8.0, 95% CI 1.79 -38.6). On multiple regression analysis, we could not identify any particular variable that could predict hypoxemia. Secondary pneumonia developed in 16 (33.3%), with the duration of PICU stay being longer in these patients as against those who did not (144 hours vs 72 hours, p <0.05). Two (4.2%) children died and one suffered hypoxic sequelae. Prior lavage, hypoxemia at admission, need for ventilation, secondary sepsis and ventilator related complications were associated with poor outcome.

Metabolic responses of the teleost Hoplias malabaricus to high levels of environmental nitrite

The metabolic responses of Hoplias malabaricus to hypoxia caused by nitrite exposure was studied and compared to previous data of hypoxia caused by low environmental oxygen concentrations. These metabolic responses were analyzed from the contents of glycogen, glucose, lactate and pyruvate in liver, red and white muscle, heart and plasma. Glycogen mobilization provided clues to explain the metabolic behavior of the organism against internal hypoxia. The ratio of closely related metabolic intermediates was used to analyze its reaction displacement. The results permit us to conclude that H. malabaricus responds to nitrite hypoxia in the same way as when exposed to low oxygen external levels. That means hydrolyxis of hepatic glycogen followed by its synthesis in white muscle. Metabolism in the heart muscle seems to be more intense than in red muscle. Although internal and external hypoxia presented similar metabolic responses, the signiificance of this strategy remains uncertain.

Hipóxia decorrente de sedaçåo com midazolam durante anestesia peridural / Hypoxia following sedation with midazolam during epidural anesthesia

Justificativa e objetivos - Os benzodiazepínicos possuem açäo sedativa por excelência e säo habitualmente escolhidos para a sedaçäo de pacientes submetidos a bloqueios raquídeos. O midazolam entretanto, deprime a ventilaçäo por açäo central e promove variados graus de obstruçäo respiratória por seu efeito relaxante sobre a musculatura da orofaringe. Considerando-se que a hipóxia está na gênese de um grande número de acidntes durante anestesias e pode agravar os efeitos tóxicos dos anestésicos locais sobre o miocárdio, o objetivo deste trabalho foi estudar os efeitos de doses sedativas de midazolam sobre a saturaçäo da hemoglobina pelo oxigênio (SpO2) em pacientes a anestesia peridural. Método - Participaram do estudo oitenta pacientes do sexo feminino, com idades entre 38 e 46 anos, estado físico ASA I, aleatoriamente divididas em dois grupos A e B, escaladas para abdominoplastias estéticas. As pacientes näo receberam medicaçåo pré-anestésica e foram submetidas à anestesia peridural lombar, através de punçäo única em L1L2, com bupivacaína a 0,5 por cento em volume fixo de 25 ml. As pacientes foram sedadas com midazolam na dose de 0,1 mg.kg -1, por via venosa, após a instalaçäo do bloqueio sensitivo cujo nível foi registrado. Nas integrantes do grupo A, colocou-se máscara com fluxo de oxigênio, 3L. min -1). Nas pacientes do grupo B a máscara, com fluxo idêntico, só foi colocada quando a SPO2 atingiu 90 por cento. As pacientes foram monitorizadas com: eletrocardiopatia contínua (D11), pressåo arterial sistólica e diastólica por esfigmomanometria e SpO2 contínua. Os valores obtidos foram anotados na sequência: antes da punçäo peridural, após a instalaçäo do bloqueio e a cada minuto após a injeçäo do midazolam por cerca de quinze minutos. Para efeitos de cálculos foram utilizadas as médias dos valores de antes da punçäo, após o bloqueio e no quinto...

Nalbufina v/s fentanyl en la inducción anestésica de colecistectomía laparoscópica: efectos adversos posoperatorios precoces / Nalbuphine v/s fentanyl in the anesthesic induction of laparoscopy cholecytectomy: early adverse effects in postoperatory

Los opiáceos usados en la anestesia pueden contribuir a la emesis posoperatoria; el uso de un agonista-antagonista puede tener varias ventajas. Objetivos: comparar el fentanyl con la nalbufina, usados en la inducción anestésica, en cuando a dolor en la inyección, sedación, hipoxemia e incidencia de naúseas y vómitos posoperatorios de colecistectomía laparoscópica. Materiales y métodos: en forma aleatoria y doble ciego estudiamos 40 adultos sometidos a colecistectomía laparoscópica. Todos se premedicaron con 7,5 mg de midazolam oral 60-90 minutos antes de la cirugía. En pabellón el Grupo I (n=20) recibió fentanyl 2 ugùkg-1 ev y el Grupo II (n=20), nalbufina 200 ugùkg-1; la inducción continuó con tiopental 5-7 mgùkg-1, vecuronio 0,1 mgùkg-1 y droperidol 20 ugùkg-1. La mantención fue con N2O/O2 al 50 por ciento e isoflurano. Se evaluó dolor con la inyección y en el posoperatorio cada 30 minutos por 2 horas, la sedación, hipoxemia (SpO2<90 por ciento por 30 segundos) y náuseas y vómitos. Estas últimas fueron evaluadas además a las 9 horas. Resultados : sólo hubo diferencias entre los grupos en la incidencia de dolor con la inyección: 0 por ciento en el Grupo I versus 20 por ciento en el Grupo II (p=0,035). Conclusión: el uso de la nalbufina se asoció a dolor durante la inyección y al igual sedación, hipoxemia y emesis posoperatoria que el fentanyl en colecistectomía laparoscópica

Further studies on the hypoxia produced by canatoxin in rats

Canatoxin, a convulsant neurotoxin from the seeds of Canavalia ensiformis, induces lipoxygenase-dependent hypoxia in rats which is blocked by hexamethonium. The purpose of the present study was to examine the relationship between canatoxin-induced hypoxia and bronchoconstriction. Since several effects of the toxin are very similar to those described for morphine and opioid-like peptides, the effects of opioid antagonists were also investigated. Pretreatment of male, adult Wistar rats (200-250 g) with cyproheptadine (80 ug/kg, ip, N=6) and isoproterenol (100 ug/kg, ip, N+6) partially blocked (% variation of pO2:CNTX alone: -26.67 ñ 2.56, N=6; with cyproheptadine: 16.15 ñ 2.97*, N=6; with isoproterenol: 17.73 ñ 1.93*, N=6; *P<0.05 as compared to CNTX alone) the hypoxia but no effect was observed with diphenhydramine (2 mg/kg, ip, N=6) or atrophine (2 mg/kg, ip, N=6). The hypoxemic effect of canatoxin (100 ug/kg iv 20 min, N=6) was also almost completely blocked with either naloxone (1 mg/kg, sc, N=6) or naltrexone (5 mg/kg, sc, N=6). The results presented here provide evidence suggesting that both opioid peptides and bronchoconstriction seem to play a role in the hypoxia caused by canatoxin

Arterial hypoxemia and pulmonary functional changes during hemodialysis: a comparison between acetate and bicarbonate dialysis

This study was designed to evaluate the effect of bicarbonate and acetate dialysate on hypoxemic, acid base status and pulmonary functions during hemodialysis. Forty patients with acute uremic symptoms and signs were selected, 20 of them were dialyzed by acetate dialysate and the other 20 by bicarbonate dialysate. Arterial and venous blood samples as well as pulmonary function studies were done to every patient before, at one hour and post dialysis. The results showed that hypoxemia is more marked in acetate dialysis after one hour. Bicarbonate and pH showed a significant improvement by both types of dialysis, but significantly more with bicarbonate dialysis. Also, pulmonary functions showed an improvement in both types of dialysis but more significant in bicarbonate dialysis

Alterations in rat carbohydrate metabolism induced by canatoxin as a probable consequence of primary hypoxia

Canatoxin, a protein displaying lipoxygenase-activating properties isolated from Canavalia ensiformis seeds, induces hypoxia and hyperglycemia in male rats. Liver glycogen, blood glucose and lactate levesls were measured in male and female rats after canatoxin (50 mU, iv) injection. Increased levels of serum glutamic oxaloacetic transaminase activity were used as an indicator of hepatic injury. There was no sex-related difference observable during canatoxin-induced hypoxia but male and female rats did whow different patterns of metabolic change and hepatic injury after toxin observed in male rats while female rats showed only hypoglycemia and glycogenolysis. Pretreatment of male rats with either glucose, diazepam or hexamethonium abolished both the hypoxia and hepatic injury and the metabolic alterations produced by toxin injection. The results suggest that the metabolic alterations and hepatic injury detected after canatoxin injection may be a consequence of primary hypoxia

Convulsions induced by canatoxin in rats are probably a consequence of hypoxia

Canatoxin, a convulsant neurotoxin from the seeds of Canavalia ensiformis, induces lipoxygenase-dependent hypoxia and sex-related alterations of carbohydrate metabolism in rats which are blocked by glucose, diazepam and hexamethonium. The present study analyzes the possible causal relationship between the convulsant action of canatoxin and its effects on carbohydrate metabolism. The incidence of canatoxin-induced convulsions was greater in male than in female rats. Pretreatment of male rats with drugs that block hypoxia, such as glucose (2.5 g/kg,iv,15 min), diazepam (5 mg/kg,ip, at 48 h, 24 animals against convulsions, respiratory distress and death. These results suggest that canatoxin/induced convulsions are probably the consequence of hypoxia and both effects are mediated by lipoxygenase activation