Oxidative stress and changes in hematological and biochemical biomarkers in Crotalus durissus terrificus (South American rattlesnake) venom-induced acute kidney injury in rats / Estrés oxidativo y alteraciones en biomarcadores hematológicos y bioquímicos en lesión renal aguda inducida por el veneno de Crotalus durissus terrificus (cascabel de America del Sur) en ratones

Abstract Acute kidney injury (AKI) is the major cause of mortality following bites by the South American rattlesnake Crotalus durissus terrificus. We investigated the early onset of Crotalus durissus terrificus venom-induced AKI in rats within 2 h of venom injection and its attenuation by antivenom. Several biomarkers were used to monitor AKI in the absence or presence of antivenom. Male Wistar rats were divided into five groups (n=5 each): G1, rats injected with saline (control); G2, rats injected with venom (6 mg kg-1, intraperitoneally) and euthanized after 2 h to evaluate AKI; G3 and G4, rats injected with 0.9% sterile saline or antivenom 2 h after venom, respectively, and monitored until death or up to 24 h post-venom, and G5, rats injected with antivenom alone and monitored for 24 h. Blood, urine and renal tissue samples were collected immediately after death to assess oxidative stress, hematological and biochemical alterations, and renal histological damage. Venom caused AKI within 2 h (G2) that persisted for up to 8.2 ± 1.6 h (G3), as confirmed by increases in blood urea, creatinine, and renal proteinuria; these increases were attenuated by antivenom. There were no changes in blood protein concentrations in G2 and G3, whereas there were increases in blood reduced glutathione, glutathione peroxidase, and plasma TBARS (but not in catalase) that were attenuated to varying extents by antivenom. There were no marked changes in platelets or leukocytes, but an increase in erythrocytes after 8.2 h with venom alone was attenuated by antivenom. Renal glomerular and tubular damage was greatest after 2 h post-venom groups alone was attenuated by antivenom. Renal glomerular and tubular damage was greatest after 2 h post-venom and declined thereafter. Venom caused early-onset AKI, with variable effects on lipid peroxidation and oxidative stress. Antivenom attenuated the AKI, as shown by the decrease in blood urea and the normalization of proteinuria, without protecting against lipid peroxidation.

Resumen La injuria o lesión renal aguda (LRA) es la mayor causa de mortalidad debido a las mordeduras por cascabeles Crotalus durissus terrificus. Se estudió la instalación precoz de LRA, en ratas, inducida por el veneno de Crotalus durissus terrificus después de 2 h de su inoculación y la atenuación por el antiveneno. Se utilizaron diversos biomarcadores para monitorear LRA en ausencia o presencia del antiveneno. Ratas Wistar machos fueron divididos en 5 grupos (n=5 por grupo): G1, ratas inoculadas con solución salina (control); G2, ratas inoculadas con veneno (6 mg kg-1 dosis, vía intraperitoneal), y sacrificadas después de 2 h para evaluar LRA; G3 y G4, ratas inoculadas con 0.9% de solución salina esterilizada o antiveneno luego de 2 h después de inoculado el veneno, respectivamente, y monitoreadas hasta su muerte o hasta 24 h después de inoculado el veneno; y G5, ratas inoculadas con antiveneno solo y monitoreadas durante 24 h. Las muestras de sangre, orina, y tejido renal fueron colectadas inmediatamente después de la muerte de los animales para evaluar estrés oxidativo, alteraciones hematológicas y bioquímicas, y daño histológico renal. El veneno causó LRA dentro de las 2 h (G2) persistiendo durante más de 8,2 ± 1,6 h (G3), estando esto confirmado por el incremento de urea sanguínea, creatinina, y proteinuria renal; estos aumentos disminuyeron con la aplicación del antiveneno. No se observaron alteraciones en las concentraciones de proteínas sanguíneas en G2 y G3, mientras que se encontraron incrementos en glutatión reducido sanguíneo, glutatión peroxidasa y TBARS plasmática (pero no en catalasa), que disminuyeron con la aplicación del antiveneno aunque en diferente grado. No ocurrieron alteraciones marcadas de plaquetas o leucocitos, mientras que el aumento de glóbulos rojos observado luego de 8,2 h de la inoculación con veneno, disminuyó con el antiveneno. El daño renal glomerular y tubular fue más importante luego de 2 h de la inoculación con veneno y posteriormente disminuyó. El veneno causó LRA precoz a las 2 h, con efectos variables sobre la peroxidación lipídica y el estrés oxidativo. El antiveneno redujo el daño renal, conforme lo demostrado por la disminución en la urea sanguínea y por la normalización de la proteinuria, aunque no se observó protección contra la peroxidación lipídica.

Action of heparin and acetylcholine modulators on the neurotoxicity of the toad Rhinella schneideri (Anura: Bufonidae) in Brazil / Acción de la heparina y moduladores de acetilcolina en la neurotoxicidad del sapo Rhinella schneideri (Anura: Bufonidae) en Brasil

Abstract Introduction: Rhinella schneideri is a toad widely distributed in South America and its poison is characterized by inducing cardiotoxicity and neurotoxicity. Objective: In this work, we investigated pharmacological strategies to attenuate the peripheral neurotoxicity induced by R. schneideri poison in avian neuromuscular preparation. Methods: The experiments were carried out using isolated chick biventer cervicis preparation subjected to field stimulation for muscle twitches recordings or exposed to acetylcholine and potassium chloride for contracture responses. Results: Poison (10 μg/ml) produced complete neuromuscular blockade in chick biventer cervicis preparation within approximately 70 min incubation (times for 50 and 90 % blockade: 15 ± 3 min and 40 ± 2 min, respectively; P < 0.05, N= 5); contracture responses to exogenous acetylcholine and KCl were unaffected by poison indicating no specificity with postsynaptic receptors or myotoxicity, respectively. Poison (10 μg/ml)-induced neuromuscular blockade was not prevented by heparin (5 and 150 IU/ml) under pre- or post-treatment conditions. Incubation at low temperature (23-25 °C) abolished the neuromuscular blockade; after raising the temperature to 37 °C, the complete neuromuscular blockade was slightly slower than that seen in preparations directly incubated at 37 °C (times for 50 and 90 % blockade: 23 ± 2 min and 60 ± 2.5 min, respectively; P < 0.05, N= 4). Neostigmine (3.3 μM) did not reverse the neuromuscular blockade in BC preparation whereas 3,4-diaminopyridine (91.6 μM) produced a partial and sustained reversal of the twitch responses (29 ± 7.8 % of maximal reversal reached in approximately 40 min incubation; P < 0.05, N= 4). Conclusions: R. schneideri poison induces potent peripheral neurotoxicity in vitro which can be partially reversible by 3,4-diaminopyridine.

Resumen Introducción: Rhinella schneideri está ampliamente distribuida en Suramérica y su veneno es caracterizado por inducir cardiotoxicidad y neurotoxicidad. Objetivo: En este trabajo, investigamos estrategias farmacológicas para atenuar la neurotoxicidad periférica inducida por el veneno de R. schneideri en preparaciones neuromusculares de aves. Métodos: Los experimentos fueron realizados usando preparaciones de biventer cervicis de pollos sometidas a estimulación de campo para el registro de las contracciones musculares o expuestas a la acetilcolina y al cloruro de potasio para la respuesta contractural. Resultados: El veneno (10 µg/ml) provocó un bloqueo neuromuscular completo en las preparaciones después de aproximadamente 70 min de incubación (tiempos para 50 y 90 % de bloqueo: 15 ± 3 min y 40 ± 2 min, respectivamente; P < 0.05, N = 5); las contracturas en respuesta a la acetilcolina y el KCl exógenos no fueron afectadas por el veneno, indicando que no hay una interacción especifica con receptores postsinápticos o miotoxicidad respectivamente. El bloqueo neuromuscular causado por el veneno (10 µg/ml) no fue prevenido por la heparina (5 y 150 UI/ml) bajo condiciones pre y post-tratamiento. La incubación a bajas temperaturas (23-25 ºC) abolió el bloqueo neuromuscular; después de aumentar la temperatura a 37 ºC, el bloqueo neuromuscular total fue levemente más lento que el visto en preparaciones directamente incubadas a 37 ºC (tiempos para 50 y 90 % de bloqueo: 23 ± 2 min y 60 ± 2.5 min, respectivamente; P < 0.05, N= 4). Neostigmina (3.3 µM) no revirtió el bloqueo neuromuscular, mientras que 3.4-diaminopiridina (91.6 µM) produjo una reversión parcial y sostenida de las respuestas neuromusculares (29 ± 7.8 % de la reversión máxima alcanzada en aproximadamente 40 min de incubación; P < 0.05, N = 4). Conclusiones: El veneno de R. schneideri indujo neurotoxicidad periférica potente in vitro, el cual puede ser revertido por 3.4-diaminopiridina.

Use of different matrices to construct the standard curve for the paracetamol dosage by visible spectrophotometry / Uso de diferentes matrizes na construção da curva padrão para a dosagem de paracetamol por espectrofotometria visível

ABSTRACT Introduction: Acute paracetamol poisoning is confirmed by the determination of its serum level and allows assessing the risk of hepatotoxicity, which can be monitored by the Rumack-Matthew nomogram for the administration of the N-Acetylcysteine antidote, as well as for the prognosis of intoxication. Objective: Because of its analytical importance, we evaluated the influence of different matrices (ultrapure water, serum, and plasma) on the construction of the paracetamol calibration curve, aiming to reduce the analytical cost and facilitate its implementation in clinical and emergency laboratories. Material and methods: A standard stock solution of paracetamol of 1 mg ml-1 was obtained, from which appropriate dilutions originated the following concentrations 20, 50, 100, 150, 200, 250, and 300 mg l-1 in the different matrices, in triplicate, reading at complete after 430 nm in spectrophotometer and reproduced after three months. The results were statistically analyzed (p < 0.05). Results and discussion: Good laboratory practices include remaking the calibration curve when stock reagents are remade aiming to readjust the line equation indicated by a measuring instrument. The biological samples indicated as matrices on a calibration curve are usually serum and plasma. However, these biological products, when commercially purchased, are of high cost. Ultrapure water can replace serum and plasma in the paracetamol calibration curve according to the linearity of the curve, which showed the same trend line for the three matrices. Conclusion: The three matrices can be used in the construction of the paracetamol calibration curve, but the use of ultrapure water reduces the analysis costs.

RESUMEN Introducción: La intoxicación aguda por paracetamol se confirma mediante la determinación de su nivel sérico y permite evaluar el riesgo de hepatotoxicidad, que puede ser monitorizado mediante el nomograma de Rumack-Matthew para la administración del antídoto N-acetilcisteína, así como para el pronóstico de intoxicación. Objetivos: Por su importancia analítica, se evaluó la influencia de diferentes matrices (agua ultrapura, suero y plasma) en la construcción de la curva de calibración del paracetamol, con el objetivo de reducir el costo analítico y facilitar su implementación en laboratorios clínicos y de emergencia. Material y métodos: Se obtuvo una solución madre del estándar (stock) de paracetamol de 1 mg ml-1, de la cual se originaron diluciones adecuadas para obtener las siguientes concentraciones de 20, 50, 100, 150, 200, 250 y 300 mg l-1 con las diferentes matrices, por triplicado, con lectura a 430 nm en epectrofotômetro, reproduciéndose a los tres meses. Los resultados se analizaron estadísticamente (p < 0,05). Resultados y discusión: Las buenas prácticas de laboratorio incluyen rehacer la curva de calibración cuando se rehacen los reactivos del estándar con el fin de reajustar la ecuación lineal indicada por un instrumento de medición. Las muestras biológicas indicadas como matrices en una curva de calibración suelen ser suero y plasma. Sin embargo, estos productos biológicos cuando se compran comercialmente son de alto costo. El agua ultrapura puede reemplazar el suero y el plasma en la curva de calibración de paracetamol de acuerdo con la linealidad de la curva, que mostró la misma línea de tendencia para las tres matrices. Conclusión: Las tres matrices pueden usarse en la construcción de la curva de calibración de paracetamol, pero el uso de agua ultrapura reduce los costos de análisis.

RESUMO Introdução: A intoxicação aguda pelo paracetamol é confirmada pela determinação de seu nível sérico e permite avaliar o risco de hepatotoxicidade, que pode ser monitorado pelo nomograma Rumack-Matthew para a administração do antídoto N-acetilcisteína, bem como para o prognóstico da intoxicação. Objetivos: Diante de sua importância analítica, avaliamos a influência de diferentes matrizes (água ultrapura, soro e plasma) na construção da curva de calibração do paracetamol, visando diminuir o custo analítico e facilitar a sua implantação em laboratórios clínicos e de urgência. Material e métodos: Obtivemos uma solução estoque padrão de paracetamol de 1 mg ml-1, da qual originaram diluições apropriadas para se obter as concentrações de 20, 50, 100, 150, 200, 250 e 300 mg l-1 com as diferentes matrizes, em triplicata, com leituras em espectrofotômetro a 430 nm, sendo reproduzidas após três meses. Os resultados foram analisados estatisticamente (p < 0,05). Resultados e discussão: Nas boas práticas de laboratório, inclui-se o refazimento da curva de calibração quando os reagentes estoques são refeitos visando ao reajuste da equação de reta indicado por um instrumento de medição. As amostras biológicas indicadas como matrizes em uma curva de calibração são, usualmente, soro e plasma. Porém, esses produtos biológicos quando adquiridos comercialmente são de custo elevado. A água ultrapura pode substituir soro e plasma na curva de calibração do paracetamol em função da linearidade da curva, a qual mostrou a mesma linha de tendência para as três matrizes. Conclusão: As três matrizes podem ser utilizadas na construção da curva de calibração do paracetamol, mas o uso de água ultrapura diminui os custos da análise.

Estudo comparativo entre duas técnicas de dosagem de metemoglobina (MHb) / Comparative study between two techniques of methemoglobin (MHb) determination

A hemoglobina é a proteína responsável pelo transporte de oxigênio, função vital ao organismo. A oxidação de um átomo de ferro da hemoglobina resulta na formação de MHb, condição que pode ser de origem congênita ou adquirida. Metemoglobinemia é caracterizada quando uma concentração superior a 2% (Evelyn e Malloy, 1938; Hegesh et al., 1970) ou a 3,8% (Naoum et al.,2004) da hemoglobina encontra-se na forma oxidada. O objetivo desta pesquisa, aprovada pelo Comitê de Ética em Pesquisa da UNISO,foi verificar a correlação existente entre a técnica de Hegesh et al. (1970) com a recente proposta por Naoum et al. (2004), atravésdo coeficiente de correlação (r) de Pearson. Os voluntários (50 estudantes da UNISO) que participaram da pesquisa após assinarem o Termo de Consentimento Livre e Esclarecido, eram hematimetricamente normais e não-fumantes. Obteve-se um coeficiente decorrelação linear próximo a 1 (r=0,93), indicando correlação positiva entre os métodos e estatisticamente significativa pelo teste t-Student (p<0,01). Embora não se possa afirmar que exista diferença estatística entre as duas técnicas, dado que são medidas em escalasdiferentes, conclui-se que a técnica de Naoum é vantajosa sobre a de Hegesh quanto à estabilidade, toxicidade de reagentes, riscos ao analista e custos.

The hemoglobin is a protein responsible by the transport of oxygen, vital function to the organism. Methemoglobin (MHb) occurs when the hemoglobin is oxidized to the ferric form, condition that could have genetic or acquired source. Methemoglobinemia is characterized when level higher to 2% (Evelyn e Malloy, 1938; Hegesh et al., 1970) or to 3,8% (Naoum et al., 2004) of hemoglobin is oxidized. The objective of this study, approved by Committee for Ethics in Clinical Research (UNISO) and after obtained the Informed Consent, was to verify the existent correlation between the Hegesh et al. (1970) with the recent proposed by Naoum et al. (2004) techniques, by using of Person’s coefficient (r). The volunteers (50 students from UNISO) were with normal hematimetric values and were no-smokers. A coefficient of linear near to 1 was obtained (r=0,93), indicating a significative (p<0,01) and positive correlation between the techniques. Although the techniques could not be compared statistically, since the scale are not equals, we can conclude that the Naoum technique is advantageous on the Hegesh relative to the analytical stability, reagents toxicity, risks to analyst and costs.

A study of the myotoxicity of bothropstoxin-i using manganese in mouse phrenic nerve-diaohragm and extensor digitorum longus preparations

Bothropstoxin-I (BthTX-I) from Bothrops jararacussu snake venom has a predominantly postsynaptic action that is responsible for this toxin´s myotoxicity. However, BthTX-I also has a presynaptic action that is counteracted by Mn2+, a reversible neuromuscular blocker that acts predominantly presynaptically. In this work, we used two nerve-muscle preparations (mouse phrenic nerve-diaphragm - PND and extensor digitorum longus - EDL) to investigate the ability of Mn2+ to protect against the myotoxicity of BthTX-I. The preparations were incubated with Tyrode solution (control), BthTX-I, or Mn2+ alone. BthTX-I (1.4 µM) produced irreversible blockade in both preparations, whereas the blockade by Mn2+ (0.9 mM) was total and reversible in PND but just partially reversible in EDL. Pretreating the preparations with Mn2+ resulted in 100% and 80% protection against BthTX-I-induced blockade, respectively. However, when Mn2+ (0.9 or 1.8 mM) and BthTX-I (1.4 µM) were co-incubated for 30 min before testing, the blockade was faster and sustained. Washing the preparations resulted in complete, sustained recovery in those exposed to 1.8 mM Mn2+ but not to 0.9 mM Mn2+. Morphological analysis showed that the extent of fiber damage by BthTXI (1.4 µM) was 82% (PND) and 68.5% (EDL), and that Mn2+ (0.9 mM) afforded 40% protection in both preparations and reduced the increase in muscle fiber cross-sectional area by 20% and 15%, respectively, compared to BthTX-I alone. Mn2+ (0.9 mM) significantly attenuated the release of creatine kinase by BthTXI. The low creatine kinase activity resulted from a protective action of Mn2+ on the sarcolemma and from direct inactivation of the released enzyme. These results show that Mn2+ prevents membrane disruption by BthTX-I and can protect against the myotoxicity and neurotoxicity caused by this toxin.

Effects of manganese ions in the neuromuscular junction

The neurotoxic effects of manganese occured mainly from its inhalation are well described in the literature. In this study we have been demonstrated the potent and reversible effect of manganese ions (Mn²+) on neuromuscular transmission using conventional myographic. The Mn²+ mechanism wich causes reversible blockade at neuromuscular junction was investigated in isolated mouse phrenic nerve-diaphragm (PND) preparations. As much Mn²+ 0.9 mM as Mn²+ 1.8 mM produced rapid neuromuscular blockade (50% in < 4 min), but only the lower concentration reversed spontaneously. The use of d-tubocurarine (5.8 µM), 3,4-diaminopyridine 3,4-DAP, 0.09 mM) and dantrolene (10 µM) excluded the involvment of nicotinic receptors, K+ channels and ryanodine receptors, respectively, as the potential target for this ion. Manganese acts an early competitive antagonist and after as an agonist of Ca²+, indicating that this ion may probably act via Ca²+ cannels...

Análise dos casos de intoxicação atendidos pelo Conjunto Hospitalar de Sorocaba / Analysis of intoxication cases admitted to the Conjunto Hospitalar de Sorocaba

The notification of intoxication is not compulsory in Brazil and this data is underestimated, although is recognizedly a public health problem. The objective of this article was to evaluate the intoxication case admitted to the hospitalar unity of regional reference, the Conjunto Hospitalar de Sorocaba (CHS). It was made a retrospective analysis of the datas (date, age, gender and toxic agent) obtained from bulletins of poisoned patients between september 2002 to septemmber 2003. Analysis was performed, initially, using a descriptive analysis following by Pearson Chi-Square and Fisher's Exact tests. There were 2,992 poisoning cases: the predominant age range was 36-50years: gender: male predominance (2,754 cases: 92%); toxic agent: abusive drugs (2,721 cases; 90.9%) with alcoholic predominance (2,383 cases; 87.6%), use of medicine together with dependence between toxic agent and gender (p<0.01), showing that abusive drugs are more used by men than women, whwreas the medicine are more used by womwn than men. The Fisher's Exact test, on the other hand, showed that the intoxication by abusive drugs occurs between 36-50 age range (p<0.01) and the medicine occurs between 21-35 years. We conclude that the psychoactive drugs are the responsible by the intoxication cases admitted to the CHS and we suggest the adoption of measures aiming to contain the intoxication cases mainly by alcohol and medicines...