Alterações metabólicas induzidas por isquemia hepática normotérmica experimental e o efeito hepatoprotetor da ciclosporina / Induced metabolic alterations due to experimental normothermic hepatic ischemia and the hepatoprotector effect of cyclosporin

RACIONAL: Transplante de fígado é inevitavelmente associado com períodos de isquemia completa. No entanto, o tempo de oclusão do pedículo hepático é limitado pelas conseqüências da injúria pós-isquêmica do fígado. OBJETIVO: Determinar as principais alterações metabólicas ocasionadas pela isquemia hepática e a provável ação hepatoprotetora da ciclosporina. MÉTODOS: Isquemia hepática normotérmica por 60 minutos foi induzida em ratos. Em seguida, as alterações com o tempo (0, 1, 6, 24 horas) das concentrações sangüíneas e hepáticas de lactato, piruvato, glicose, corpos cetônicos e razão acetoacetato/3-hidroxibutirato, bem como o estado redox citoplasmático e mitocondrial do tecido hepático foram determinados. Outro grupo de animais foi pré-tratado com ciclosporina (10 mg/kg), sendo estudadas as alterações metabólicas no tempo 1 hora após revascularização hepática. RESULTADOS: A isquemia hepática causou elevação da concentração de lactato no fígado, sugerindo que pronunciado grau de metabolismo anaeróbico ocorreu durante o período de isquemia. Isquemia hepática acarretou ainda queda da concentração e da razão dos corpos cetônicos (acetoacetato/3-hidroxibutirato) no sangue arterial no tempo de 1 hora após revascularização. Tal fato reflete que a injuria isquêmica do fígado interfere na cetogênese. CONCLUSAO: O tratamento com ciclosporina causa elevação das concentrações dos corpos cetônicos e da razão acetoacetato/3-hidroxibutirato no sangue arterial após 1 hora de reperfusão hepática, sugerindo que esta droga acelera a cetogênese e, conseqüentemente, a recuperação da lesão isquêmica do fígado.

Predictive Comparisons of Procalcitonin (PCT) Level, Arterial Ketone Body Ratio (AKBR), APACHE III Score and Multiple Organ Dysfunction Score (MODS) in Systemic Inflammatory Response Syndrome (SIRS)

Procalcitonin (PCT) is a newly introduced marker of systemic inflammation and bacterial infection. A marked increase in circulating PCT level in critically ill patients has been related with the severity of illness and poor survival. The goal of this study was to compare the prognostic power of PCT and three other parameters, the arterial ketone body ratio (AKBR), the acute physiology, age, chronic health evaluation (APACHE) III score and the multiple organ dysfunction score (MODS), in the differentiation between survivors and nonsurvivors of systemic inflammatory response syndrome (SIRS). The study was performed in 95 patients over 16 years of age who met the criteria of SIRS. PCT and AKBR were assayed in arterial blood samples. The APACHE III score and MODS were recorded after the first 24 hours of surgical ICU (SICU) admission and then daily for two weeks or until either discharge or death. The patients were divided into two groups, survivors (n=71) and nonsurvivors (n=24), in accordance with the ICU outcome. They were also divided into three groups according to the trend of PCT level: declining, increasing or no change. Significant differences between survivors and nonsurvivors were found in APACHE III score and MODS throughout the study period, but in PCT value only up to the 7th day and in AKBR only up to the 3rd day. PCT values of the three groups were not significantly different on the first day between survivors and nonsurvivors. Receiver operating characteristic (ROC) curves for prediction of mortality by PCT, AKBR, APACHE III score and MODS were 0.690, 0.320, 0.915 and 0.913, respectively, on the admission day. In conclusion, PCT could have some use as a mortality predictor in SIRS patients but was less reliable than APACHE III score or MODS.

Hiperuricemia em obesas sob dieta altamente restritiva / Hyperuricemia on obese women with restrictive highly diet

O trabalho verifica e analisa hiperuricemia em nove mulheres obesas, com índice de massa corporal (IMC) >35kg/m2, sob dieta altamente restritiva (DAR, 400-600kcal/dia) durante 6 semanas. As primeiras duas semanas foram para o diagnóstico clínico e adaptação dietética. Semanalmente foram medidas cetonúria e uricemia e na 4ª. semana foi também determinada a excreção urinária de ácido úrico. A média (ñdp) do IMC foi de 54ñ12 e 49ñ11 kg/m2, respectivamente na admissão e alta hospitalar, correspondendo a uma perda de peso de 14ñ2kg (p<0,05). Das pacientes, 78 por cento apresentavam hiperuricemia assintomática, com níveis >5,7mg/dl, atingindo, durante o estudo, o valor máximo de 12mg/dl. Duas pacientes, com níveis de uricemia >l0mg/dl, receberam alopurinol. A uricosúria, na 4ª. semana, foi de 770ñ262mg/24 hs. 33 por cento das pacientes excretaram entre 300-700mg, considerados valores normais, e 67 por cento excretaram mais do que 700mg. Nenhuma foi considerada hipoexcretora. Sugere-se que pacientes obesos submetidos à DAR tenham, além de uricemia, os valores de uricosúria monitorizados. Quando ocorrer hiperuricemia, a introdução de fármacos que inibem a síntese de ácido úrico estaria indicada.

Effect of fasting on serum glucose lipids and ketone bodies concentration during Ramadan in Arsenjan, Iran

Serum levels of glucose, cholesterol, triglyceride and acetoacetate were measured in a group of 91 healthy men [16-76 years], on the first, 10th and 28th days of Ramadan. There was a significant decrease [P<0.001] in serum glucose levels on the 10th and 28th days of Ramadan. Serum acetoacetate levels were significantly increased [P<0.001] on the 10th and 28th days of Ramadan. Serum triglycerides levels were significantly decreased [P<0.01] on the 10th day but there was a small increase in serum triglycerides on the 28th days of fasting [NS]. Serum cholesterol was significantly increased [P<0.001] on the 10th day but a small decrease was in serum cholesterol in the 28th day of fasting [NS]. Analysis of three days dietary recall of subjects before and during Ramadan indicates that protein intakes was significantly increased[P<0.001]. There was small increase in fat intake but it was not significant, however carbohydrate and calorie intake were significantly decreased [P<0.001]. There was a small but not significant fall in body weight and Body Mass Index [BMI]. Although some changes in serum concentrations of glucose, acetoacetate, cholesterol and triglyceride occur during Ramadan in men but none of them reach pathological proportions and since Ramadan only occurs once a year it would be unlikely to have any adverse effects on normal subjects

Enfermedades metabólicas en el recién nacido / Metabolic diseases in the newborn

Se revisan las enfermedades metabólicas que pueden manifestarse en el período neonatal, destacando los elementos clínicos y de laboratorio que el pediatra general debe considerar para aproximarse al diagnóstico y ofrecer el manejo inicial apropiado de estos pacientes. La evaluación de los gases en sangre, el hiato aniónico, el ácido láctico en el suero, la amenomia y la glicemia debe hacerse cuidadosamente para un diagnóstico diferencial apropiado. El tratamiento incial incluye, además del manejo general correspondiente a cualquier recién nacido enfermo, el control de la hipoglicemia, la acidosis y los trastornos del metabolismo del agua y los electrolitos, la restricción de las proteínas, el aporte energético necesario, la suplementación de cofactores metabólicos considerados específicos y la solicitud oportuna de apoyo especializado

A simple chemical method for the oxidation of beta-hydroxybutyrate; application of the method for the estimation of ketone bodies.

A simple one-step method employing potassium persulphate as an oxidising agent in presence of catalyst, Ag2+, for the oxidation of beta-hydroxybutyrate (beta-OHB) to acetoacetate (AcAc) has been developed and standardized. Under the condition of assay, beta-OHB (0.079-0.395 microM) was quantitatively transformed to AcAc. The reaction linearity was observed from 0.079 to 0.634 microM. Optimum conditions were: pH, 6.2; temp., 40 degrees C; persulphate saturation, 40% and catalyst, 1.82 mM. Under the experimental condition, no reversal of inhibition caused by chloride (22.96 mM) was observed at Ag+ concentrations (9.09 and 18.18 mM), while higher conc. of Ag+ (27.27 mM) caused significant reversal of inhibition (about 60%). The maximum reversal of inhibition was achieved at Ag+ (36.36 mM). The level of ketone bodies, when estimated by the present method, was greatly enhanced during starvation period and about 2- and 12-fold higher level of ketone bodies was observed (compared to control) in rats fasted for 24 and 48 hr respectively.