Sodium alendronate: proposal and reliability of indicators

Abstract The present study proposes and evaluates the test-retest reliability of indicators of the correct use of sodium alendronate in elderly patients. This is a test-retest reliability study for use of sodium alendronate. Six questions to evaluate the correct use of this medicine were elaborated after analysis of information in the literature. Data collection was performed through questionnaires in face-to-face in-home interviews by previously trained interviewers. The participants were initially interviewed (test) when they agreed to participate in the study, and secondly (retest), after a period of 7 to 14 days from the first interview. The reliability of the questions was evaluated by means of the agreement percentage and the Kappa coefficient. Fifty-seven pairs (test-retest) were obtained. The mean age was 69.3 (SD = 6.9) years, the majority (92.5%) completed elementary education, and declared themselves white (50.9%). All the questions presented high concordance ranging from 79.0% to 98.3%. The Kappa values ranged from 0.1 (low) to 0.83 (very good). The agreement percentage and the Kappa values suggest adequate reliability of the proposed questions. We suggest that they can be used as a simple and quick way to evaluate the quality of sodium alendronate use among the elderly.

Evaluación del contenido nutricional de productos lácteos en programa de alimentación venezolano / Evaluation of the nutritional content of dairy products in the Venezuelan food program

En Venezuela se distribuyen productos lácteos en polvo a través de los Comité Locales de Abastecimiento y Producción (CLAP). Con el objetivo de evaluar la composición nutricional de catorce marcas de productos lácteos provenientes de industrias mexicanas y distribuidos en Venezuela, se realizó un estudio descriptivo y transversal, con muestreo a conveniencia de 14 marcas de lácteos obtenidas en hogares beneficiados del área metropolitana de Caracas-Venezuela. Se cotejó la información presentada en el rotulado del producto y se efectuó un análisis químico de la composición nutricional. Los valores obtenidos se compararon utilizando como referencia a la norma COVENIN. En el etiquetado se encontró que sólo 2 marcas se denominan producto lácteo y el 43% de las marcas expresan el mismo contenido nutricional en el rótulo. En la analítica química se encontró inexactitud con la información presentada en el etiquetado nutricional. El análisis de componentes principales seguido de un conglomerado jerárquico permitió diferenciar 4 clúster o grupos: 2 reales y 2 ideales. La mayoría de los productos analizados son significativamente más altos en carbohidratos y sodio (p<0,05), además de bajos en proteínas y calcio (p<0,05). En conclusión, todas las muestras evaluadas incumplen la normativa correspondiente, al presentar irregularidades en la denominación del producto e informar valores que no se corresponden con el contenido nutricional resultante de los análisis químicos(AU)

In Venezuela, powdered milk products are distributed through the Local Supply and Production Committee (CLAP). The objective was to evaluate the nutritional composition of fourteen brands of dairy products from Mexican industries distributed in Venezuela, a descriptive and cross-sectional study was conducted, with convenience sampling of 14 brands of dairy products obtained in households benefiting from the Caracas Metropolitan area - Venezuela. The information presented in the product labeling was checked and a chemical analysis of the nutritional composition was performed. The values obtained were compared using the COVENIN standard as a reference. In the labeling, it was found that only 2 brands are called dairy products and 43% of the brands express the same nutritional content on the label. The chemical analysis showed inaccuracy with the information presented in the nutritional labeling. The analysis of principal components followed by a hierarchical conglomerate allowed us to differentiate 4 clusters or groups: 2 real and 2 ideal. Most of the products analyzed are significantly higher in carbohydrates and sodium (p <0.05), as well as low in protein and calcium (p <0.05). In conclusion, all the samples evaluated fail to comply with the corresponding regulations, presenting irregularities in the product name and reporting values that do not correspond to the nutritional content resulting from chemical analyzes(AU)

A sobrecarga intravenosa de fluidos e sódio pode contribuir para a menor infusão de nutrição enteral em pacientes críticos / Intravenous overload of fluids and sodium may contribute to the lower infusion of enteral nutrition in critically ill patients

RESUMO Objetivo: Avaliar os efeitos da administração intravenosa de fluidos e sódio no primeiro dia de internação com a infusão de nutrição enteral em pacientes de terapia intensiva. Métodos: Estudo de coorte prospectivo realizado com pacientes críticos, não cirúrgicos, em ventilação mecânica internados pelo menos há 5 dias com nutrição enteral. Investigaram-se a quantidade de fluidos e sódio administrados por via venosa no primeiro dia e o volume de nutrição enteral infundido nos primeiros 5 dias. Comparou-se o volume de fluidos intravenosos do primeiro dia > 35mL/kg ou ≤ 35mL/kg de peso corporal e de sódio (acima ou abaixo do percentil 25), com o total de nutrição enteral infundida. Resultados: Estudaram-se 86 pacientes com média (± desvio padrão) de 65 ± 17 anos, sendo 54,7% do sexo feminino. Foram administrados, no primeiro dia, 3.393,7 ± 1.417,0mL de fluidos (48,2 ± 23,0mL/kg) e 12,2 ± 5,1g de sódio. Cinquenta e oito (67,4%) pacientes receberam mais de 35mL/kg de fluidos. Em 5 dias, foram ofertados 67 ± 19,8% (2.993,8 ± 1.324,4mL) da nutrição enteral. Os pacientes que receberam > 35mL/kg de fluidos intravenosos também receberam menos nutrição enteral em 5 dias (2.781,4 ± 1.337,9 versus 3.433,6 ± 1.202,2mL; p = 0,03) versus quem recebeu ≤ 35mL/kg. Pacientes com infusão de sódio intravenoso acima do percentil 25 (≥ 8,73g) no primeiro dia receberam menos volume de nutrição enteral em 5 dias (2.827,2 ± 1.398,0 versus 3.509,3 ± 911,9mL; p = 0,02). Conclusão: Os resultados deste estudo apoiam o pressuposto de que a administração de fluidos intravenosos no primeiro dia de internação > 35mL/kg e de sódio ≥ 8,73g pode contribuir para a menor infusão de nutrição enteral em pacientes críticos.

ABSTRACT Objective: To evaluate the effects of intravenous infusion of fluids and sodium on the first day of admission on infusion of enteral nutrition in the first 5 days in intensive care patients. Methods: A prospective cohort study was conducted with critical nonsurgical patients admitted for at least 5 days who were on mechanical ventilation and receiving enteral nutrition. The amount of intravenous fluids and sodium infused on the first day and the volume of enteral nutrition infused in the first 5 days were investigated. The volume of intravenous fluids > 35mL/kg or ≤ 35mL/kg of body weight and sodium (above or below the 25th percentile) infused on the first day was compared with infused enteral nutrition. Results: A total of 86 patients were studied, with a mean (± standard deviation) of 65 ± 17 years, of which 54.7% were female. On the first day, 3,393.7 ± 1,417.0mL of fluid (48.2 ± 23.0mL/kg) and 12.2 ± 5.1g of sodium were administered. Fifty-eight (67.4%) patients received more than 35mL/kg of fluids. In 5 days, 67 ± 19.8% (2,993.8 ± 1,324.4mL) of the prescribed enteral nutrition was received. Patients who received > 35mL/kg of intravenous fluids also received less enteral nutrition in 5 days (2,781.4 ± 1,337.9 versus 3,433.6 ± 1,202.2mL; p = 0.03) versus those who received ≤ 35mL/kg. Patients with intravenous sodium infusion above the 25th percentile (≥ 8.73g) on the first day received less enteral nutrition volume in 5 days (2,827.2 ± 1,398.0 versus 3,509.3 ± 911.9mL; p = 0.02). Conclusion: The results of this study support the assumption that the administration of intravenous fluids > 35mL/kg and sodium ≥ 8.73g on the first day of hospitalization may contribute to the lower infusion of enteral nutrition in critically ill patients.

Effect of 1% sodium alendronate in the non-surgical treatment of periodontal intraosseous defects: a 6-month clinical trial

Abstract Background and objectives Few studies have evaluated the effect of the topical application of sodium alendronate (ALN) on the treatment of intrabuccal bone defects, especially those caused by periodontitis. This 6-month randomized placebo controlled clinical trial aimed at evaluating the effect of non-surgical periodontal treatment associated with the use of 1% ALN, through clinical evaluations and cone-beam computed tomography (CBCT). Material and Methods Twenty individuals with chronic periodontitis underwent periodontal examination at the baseline as well as 3 and 6 months after periodontal treatment, registering clinical attachment level (CAL), periodontal probing depth (PPD), and bleeding on probing (BOP) as the clinical outcomes. After manual scaling and root planing, 40 bilateral sites with interproximal vertical bone defects were randomly treated with either 1% ALN gel or a placebo. Bone defects were evaluated through CBCT at the baseline and 6 months post-treatment. The clinical and CBCT parameters were compared using the Wilcoxon and Friedman tests (p<0.05). Results Although ALN produced a greater CAL gain when compared to the placebo at 6 months post-treatment (p=0.021), both treatments produced similar effects on the PPD, BOP, and bone height. Significant differences in bone fill were observed only in patients of the ALN group (4.5 to 3.8 mm; p=0.003) at 6 months post-treatment. Conclusions Topical application of 1% ALN might be a beneficial adjuvant to non-surgical periodontal therapy.

Salame com reduzido teor de sódio e iogurte comercial como cultura starter / Salami with reduced sodium content and commercial yogurt as starter culture / Salame reducido en sodio y yogurt comercial como cultura starter

A hipertensão arterial tornou-se na atualidade um dos grandes problemas da saúde pública em vários países, incluindo o Brasil, mudanças no estilo de vida, incluindo os hábitos alimentares são importantes para a prevenção, especificamente a redução do consumo de sódio. Este trabalho objetivou desenvolver e analisar salames desenvolvidos com redução do teor de sódio e emprego de iogurte natural comercial como cultura starter. Foram produzidos salames com adição de 1,5% de cloreto de sódio e com a mesma porcentagem de uma mistura contendo 80% de cloreto de sódio e 20% de cloreto de potássio que foram mantidos por 21 dias em temperatura de 20ºC seguido por mais 23 dias em temperatura de refrigeração. Foram avaliados a composição da massa base dos salames, a variação nos valores de pH e contagem em NMP/g de coliformes termotolerantes. O salame com redução de sódio e cultura starter de iogurte foi vantajosa, pois o produto final manteve as características físico-químicas e microbiológicas preconizadas pela legislação.(AU)

High blood pressure has become one of the major public health concerns in several countries, including Brazil. Thus, some changes in habits are necessary, including eating habits, for prevention, especially by reducing sodium intake. This work aimed at developing and analyzing salamis with reduced sodium content and the use of commercial yoghurt as starter culture. Salamis were produced with the addition of 1.5% sodium chloride, with the same percentage from a mixture containing 80% sodium chloride and 20% potassium chloride. They were stored for 7 days at 20 °C followed by further 23 days under refrigeration. The composition of the salami base mass and the variation of the pH values and the MPN/g count of thermo-tolerant coliforms were analyzed. The results showed that the substitution of 20% sodium chloride by potassium chloride did not present any changes to fermentation characteristics of the salamis, which reached pH values close to the expectations and found in the literature. The microbiological analysis showed that the salamis produced were good for consumption since values were below the maximum threshold allowed by the Brazilian legislation.(AU)

La hipertensión arterial se volvió en la actualidad uno de los grandes problemas de la salud pública en varios países, incluyendo Brasil, y cambios en el estilo de vida, así como los hábitos alimentares son importantes para la prevención, específicamente la reducción de sodio y empleo de yogurt natural comercial como cultura Starter. Se han producido salames con adicción de 1,5% de cloruro de sodio y con el mismo porcentaje de una mezcla conteniendo 80% de cloruro de sodio y 20% de cloruro de potasio que fueron mantenidos por 21 días en temperatura de 20ºC seguido por más 23 días en temperatura de refrigeración. Se evaluó la composición de la masa base de los salames, la variación en los valores del pH y conteo en NMP/g de coliformes termotolerantes. El salame con reducción de sodio y cultura starter de yogurt se hizo ventajoso, pues el producto final mantuvo las características físico químicas y microbiológicas preconizadas por la legislación.(AU)

Análise comparativa do teor de sódio presente em salgadinhos industrializados com os requerimentos para o consumo diário / Comparative analysis of sodium in industrialised snacks with requirementsfor the daily consuption

A população brasileira apresenta um padrão alimentar rico emsal, açúcar e gorduras. Paralelo a isto, observa-se o aumento noconsumo de salgadinhos industrializados em escala mundial,em crianças e em adultos. O objetivo deste estudo foi identificaro teor de sódio em salgadinhos industrializados e compará-locom seus requerimentos para consumo diário. A amostra foicomposta de 10 marcas de salgadinhos industrializados. Foramconsiderados os teores de sódio por porção apresentados nainformação nutricional das embalagens e, a partir deles, foramcalculados o teor de sódio para a quantidade total de produtona embalagem e na porção, padronizada em 25 g. O teor desódio foi comparado, por porção e por embalagem, com seusrequerimentos para consumo diário, considerando-se valores deingestão adequada (AI) e nível de ingestão máximo tolerável(UL). As marcas foram comparadas em relação ao teor de sódiona porção e no conteúdo total da embalagem, ao percentualde valor diário recomendado para sódio por porção, e aopreço. Foram calculados média, desvio padrão e coeficientede variação (CV) para as variáveis, e a relação entre preço eteor de sódio foi analisada por meio do teste de correlação dePearson. O preço e o teor de sódio dos produtos apresentaramCV muito alto, e não foi observada correlação significanteentre preço e teor de sódio. O teor de sódio no conteúdo totalda embalagem ultrapassou os requerimentos de AI e UL emuma das marcas em estudo, e não excedeu os requerimentospor porção em nenhuma delas...

The Brazilian population has a high eating pattern in salt,sugar and fat. Parallel to this, there is a worldwide increase ofmanufactured snack foods consumption in children and adults.The aim of this study was to identify the sodium content inprocessed snacks and compare it with its requirements for dailyconsumption. The sample was composed of 10 industrializedsalty snacks. The content of sodium per serving shown in thepackage’s nutrition facts was used to calculate the total sodiumcontent of the package and in a 25 g standardized portion. Thesodium content was compared, per serving and per package, withits requirements for daily consumption, considering values foradequate intake (AI) and tolerable upper intake level (UL). Thesodium content in a portion and in the package was comparedto the percentage of the recommended daily value for sodiumper serving. A possible correlation between price and sodiumcontent was also investigated. We calculated mean ± standarddeviation and coefficient of variation (CV) for the variables. Therelationship between price and sodium content was analyzed usingthe Pearson’s correlation. The price and the sodium content of theproducts presented a very high CV, and there was no significantcorrelation between price and sodium content. One of the saltysnacks of the study exceeded the requirements of AI and UL fortotal sodium content of the package, but none of them exceed therequirements for a portion...

Efeito antinatriorexigênico e ansiolítico da administração intracerebral de carvacrol em ratos: influência das vias serotoninérgicas, adrenérgicas e possíveis áreas cerebrais envolvidas / Antinatriorexigenic and anxiolytic effect of the intracerebral administration of carvacrol in rats: influence of serotonergic and adrenergic pathways and possible brain Areas involved

O óleo essencial do orégano apresenta entre seus principais constituintes o carvacrol (70%). O extrato de orégano administrado intraperitonealmente em camundongos inibe a recaptação e a degradação de neurotransmissores monoaminérgicos (dopamina, serotonina e noradrenalina) de modo dose dependente, além de aumentar os níveis de serotonina em diversas áreas cerebrais, e esses efeitos foram atribuídos ao carvacrol. O carvacrol administrado por via oral em camundongos demonstrou significativo aumento em todos os parâmetros observados no teste de ansiedade na cruz elevada. O controle central da ingestão de água e do apetite por sódio é feito por uma complexa rede interativa de circuitos inibitórios e estimulatórios. Sabe-se que tanto a noradrenalina quanto a serotonina participam do controle do apetite por sódio e desconhecem-se os efeitos do carvacrol neste comportamento. O presente estudo teve como objetivo investigar o efeito da administração intracerebroventricular de carvacrol no apetite por sódio, na sede, na ansiedade e na atividade locomotora em ratos, bem como detectar a presença de FOS em áreas cerebrais relacionadas com esses comportamentos através de FOS-IR...

The essential oil of oregano has among its main constituents carvacrol (70%). The oregano extract administered intraperitoneally in mice inhibits the reuptake of monoamine neurotransmitters degradation (dopamine, serotonin and norepinephrine) in a dose-dependent manner, and increases serotonin levels in several brain areas. The carvacrol administered orally in mice showed a significant increase in all parameters observed in the anxiety test in elevated plus maze. The control of water intake and sodium appetite is done by a complex interactive network of stimulatory and inhibitory circuits. It is known that norepinephrine, as well as serotonin, is involved in the control of sodium appetite and it is unknown the effects of carvacrol in these behaviors. The present study aimed to investigate the effect of intracerebroventricular administration of carvacrol on sodium appetite, in the anxiety and locomotor activity in rats, as well as the FOS...

Equilibrio sodio-potasio en la regulación de la hipertensión arterial / Sodium-potassium balance in the regulation of high blood pressure

La hipertensión arterial esencial es considerada como la principal causa de muerte por la OMS. La cuarta parte de la población mayor de 15 años es hipertensa, lo que representa aproximadamente un billón de personas, que tendrán un importante aumento en el año 2025 cercano al 60 por ciento. Su prevalencia aumenta en proporción lineal con el aumento de edad. Desafortunadamente, los niveles de detección, tratamiento y control efectivo de la hipertensión arterial, son deficientes a nivel de Chile y mundial, por lo que es aún un problema de salud pública no resuelto y que por tanto necesita urgente atención. La reciente Encuesta Nacional Ministerial de Salud 2009-2010 de Chile reveló una prevalencia de hipertensión arterial nacional de un 26,9 por ciento, con un 65 por ciento de conocimiento de su existencia, 37,6 por ciento en tratamiento y sólo un 16,49 por ciento de control satisfactorio. Además, dicha encuesta revela marcadores de estilos de vida poco saludables, que permiten comprender la epidemia nacional de hipertensión arterial, a través de la existencia de múltiples factores de riesgo para ella. En esta revisión nos centramos especialmente en la importancia de la relación sodio-potasio en la regulación de la presión arterial. Llama la atención que todos los estudios destacan la importancia que tiene el sodio en la génesis de la hipertensión arterial por sus efectos presores, particularmente en sujetos sensibles, y poco o nada se manifieste de las variadas acciones benéficas que posee el potasio en la regulación de la presión arterial.

The World Health Organization considers essential hypertension as a primary cause of death. Twenty-five percent of the population over 15 has high blood pressure (HBP), equivalent to a billion people. It has been predicted that this group will increase by 60 percent, lineal with age increase in the overall population. Unfortunately, detection, treatment and effective control of HBP, are deficient both in Chile and in the rest of the world, making it an unresolved health problem demanding urgent attention. The recently conducted Chilean National Health Survey (2009-2010) revealed a 26.9 percent prevalence of this condition in the population, sixty-five percent of individuals are aware of their condition, 37.6 percent are in treatment and only 16,49 percent are effectively controlled. Furthermore, the survey reveals unhealthy life-style markers, which explains the epidemic that besets the country as there are multiple risk factors at stake. This review focuses mainly on the importance of the sodium-potassium relationship in the regulation of high blood pressure. It must be pointed out that all of the studies underscore the importance of sodium in the genesis of hypertension because of its effects of blood pressure, especially in sensitive individuals, while little attention has been given to the manifold beneficial actions of potassium in the regulation of blood pressure.

Mecanismos neuro-hormonais envolvidos na regulação do apetite ao sódio: alguns aspectos / Neuro-hormonal mechanisms involved within sodium appetite: some aspects

O sódio é o principal íon do líquido extracelular e tem primordial importância para diversas funções fisiológicas. Manter a concentração plasmática do sódio dentro dos limites fisiológicos é vital para diversas espécies de animais, inclusive os humanos. Portanto, é fundamental que hajam mecanismos responsáveis pela monitorização e manutenção de níveis adequados de sódio no plasma. O apetite ao sódio, o comportamento que comanda a ingestão de sal, é estimulado por situações de deficiência sistêmica de sódio. Ao longo de décadas, diversos estudos foram desenvolvidos a fim de compreender os mecanismos neurais e hormonais envolvidos no controle desse comportamento. No entanto, muitas questões relacionadas a esse assunto ainda permanecem desconhecidas e a cada dia surgem novas evidências. Neste trabalho, foram revistos os fatos históricos, mecanismos neurais, hormonais e os achados mais recentes envolvendo apetite ao sódio.

Sodium is the most important ion of the extracellular fluid and plays an important role for many physiological functions. Maintain the sodium concentration in the plasma around of its physiological values is vital for many species of animals, including humans. Therefore, it is important that have responsible mechanisms for monitorization and maintenance of appropriated levels of plasmatic sodium. Sodium appetite, the behavioral drive to ingest salt, is stimulated by systemic sodium deficiency. Over the past decades, several studies have been performed in order to understand the neural and hormonal mechanisms involved in the control of this behavior. However, many questions related to this issue are still unknown and everyday new evidences arise. Here, we review historical facts, neural and hormonal mechanisms and recent findings involving sodium appetite.

Hypertension: Salt restriction, sodium homeostasis, and other ions.

Salt is composed of Sodium Chloride (NaCl) which in body water becomes essential electrolytes, viz., Sodium (Na + ) and Chloride (Cl - ) ions, including in the blood and other extracellular fluids (ECF). Na + ions are necessary cations in muscle contractions and their depletion will effect all the muscles in body including smooth muscle contraction of blood vessels, a fact which is utilized in lowering the blood pressure. Na+ ions also hold water with them in the ECF. Na + homeostasis in body is maintained by thirst (water intake), kidneys (urinary excretion) and skin (sweating). In Na + withdrawal, body tries to maintain homeostasis as far as possible. However, in certain conditions (e.g., during exercise, intake of drugs and in disorders causing Syndrome of Inappropriate Anti Diuretic Hormone Secretion (SIADH), diuretics, diarrhea) coupled with moderate or severe dietary salt restriction (anorexia nervosa), hyponatremia can get precipitated. Hyponatremia is one end point in the spectrum of disorders caused by severe Na + depletion whereas in moderate depletion it can cause hypohydration (or less total body water) and lower urinary volume (U v ). Moreover, salt sensitivity varies in various populations leading to different responses in relation to dietary Na + intake. Diabetes and Hypertension often co-exist but Na + withdrawal in salt sensitive subjects worsens diabetes though hypertension gets better and reverse occurs in salt loading. Therefore, Na + or salt restriction may be non-physiological. In hypertensive subjects other alternatives to Na + withdrawal could be Potassium (K + ) and Calcium (Ca 2+ ) supplementation. Further studies are required to monitor safety/side effects of salt restriction.

Hiponatremia: conduta na emergência / Hyponatremia: management in the emergency

JUSTIFICATIVA E OBJETIVOS: Definir e atualizar protocolos de tratamento e condutas em pacientes com hiponatremia na emergência médica com enfoque no diag¬nóstico causal da doença e métodos de correção do sódio sérico, consultando estudos de revisão sobre hiponatremia e distúrbios hidroeletrolíticos dos últimos 10 anos nas bases de dados LILACS, MedLine, BIREME, N England J Med e Lancet, a fim de estabelecer um protocolo de tratamento de hiponatremia na emergência. A grande prevalência da hiponatremia na emergência e como complicação aguda de inúmeras doenças, justificada pela grande dificuldade encontrada na correção dos eletrólitos de forma eficaz e que melhorem o prognóstico do paciente quando tratado precocemente. CONTEÚDO: A hiponatremia é caracterizada como o valor de sódio sérico menor que 136 mEq/L, sendo o distúrbio eletrolítico mais freqüentemente encontrado na prática clínica, presente em 6% dos pacientes internados. O tratamento da hiponatremia leva em consideração a classificação dos seus tipos, quanto a sua osmolalidade e em alguns casos à relação com a volemia do paciente, sendo feita na maioria dos casos de forma não controlada e com valores aproximados, não levando em conta outras características dos pacientes. Decorrente da grande dificuldade de se estabelecer a forma mais correta de se corrigir a volemia do paciente e a reposição do sódio, a elaboração de um guia de procedimentos e condutas a serem adotadas se justifica meio a grande prevalência da condição em pacientes portadores de doenças agudas e crônicas e frente à dificuldade de se estabelecer o tratamento mais efetivo nessas condições. As terapêuticas disponíveis seja a restrição hídrica, infusão de soluções ou uso de diuréticos são frequentemente ineficazes e com resultados nem sempre previsíveis, com potenciais efeitos secundários como a mielinólise pontina central. CONCLUSÃO: A hiponatremia é uma condição clínica comum na prática médica, sendo uma emergência responsável por altas taxas de complicações em pacientes internados. Pode manifestar-se de diferentes formas e devem ser prontamente reconhecidas pelo médico a fim de se estabelecer a correção do distúrbio eletrolítico, assim como iniciar o tratamento da doença de base do paciente. O objetivo de o tratamento ser a correção dos eletrólitos deve-se tratar cada individuo separadamente, levando em consideração as comorbidades e condições clínicas apresentadas no momento do tratamento.(AU)

BACKGROUND AND OBJECTIVES: Define and up-date treatment protocols and behaviors in patients with hyponatremia in medical emergencies with focus on casual diagnosis of the disease and methods of correction of serum sodium rising review articles on hyponatremia and electrolyte disturbances in the last 10 years in databases such as LILACS, MedLine, N England J Med, and Lancet in order to establish a protocol for treatment of hyponatremia in the emergency. The high prevalence of hyponatremia in emergency and as a complication of many acute diseases, justified by the great difficulties encountered by medical in the correction of electrolyte effectively and to improve the prognosis when treated early. CONTENTS: Hyponatremia is characterized as the value of serum sodium less than 136 mEq/L, being the most common electrolyte disorder encountered in clinical practice, affecting 6% of hospitalized patients. The treatment of hyponatremia takes into account the classification of types of hyponatremia and its osmolality and in some cases the relationship with the patient blood volume, being made in most cases in an un¬ controlled way and with approximate values, not taking into account other features patients. Due to the great difficulty in establishing the best thing to correct the patient?s blood volume replacement and sodium, the preparation of a guide to procedures and measures to be adopted is justified through the wide prevalence of the condition in patients with acute and chronic and facing difficulty in establishing the most effective treatment in these conditions. The available treatment is fluid restriction, infusion solu¬tions or diuretics are often ineffective and results not always predictable, with potential side effects such as central pon¬tine myelinolysis. CONCLUSION: Hyponatremia is a common clinical problem in medical practice, and an emergency responsible for high rates of complications in hospitalized patients. Hy¬ponatremia can manifest itself in different ways and should be readily recognized by the physician in order to establish the correction of electrolyte disturbances, and initiate treatment of the underlying disease of the patient. Even the goal of treatment is correction of electrolytes should be to treat each individual separately, taking into account comorbidities and clinical conditions presented at the time of treatment.(AU)

Effect of single oral dose of sodium rabeprazole on the intragastric pH & volume in patients undergoing elective surgery.

BACKGROUND & OBJECTIVE: While evaluating the effectiveness of drugs used for the prophylaxis of acid aspiration of gastric contents, the impact of duodeno-gastric reflux on gastric contents has not been studied earlier. This study was carried out to evaluate the effect of preanaesthetic oral administration of sodium rabeprazole on pH and volume of gastric contents in adult patients undergoing elective surgery by excluding cases contaminated with duodeno-gastric refluxate. METHODS: The patients in group C (control) in the triple blind placebo controlled trial received placebo while group S sodium rabeprazole 20 mg orally at 2100 h, a night before elective surgery. Next day, gastric contents were aspirated with a large bore, multi-orifices gastric tube passed through an endotracheal tube placed blindly in oesophagus after tracheal intubation and analyzed for the presence of bile salts, pH and volume. The pH and volume of gastric contents were the primary and duodeno-gastric reflux secondary outcome measures of the study. RESULTS: The pH and volume of group S-2 were 3.97+/-1.78 and 9.48+/-8.39 ml respectively compared with 1.90+/-0.47 and 19.60+/-18.56 ml of group C-2. Sodium rabeprazole, after excluding contaminated cases with duodeno-gastric refluxate, significantly increased the pH (P<0.001), decreased the volume of gastric contents (P<0.005) and the proportion of the patients (30.76 vs 2.63%) considered at risk compared with placebo (P<0.001) according to the criteria defined (pH < 2.5 and volume > 25 ml). Thirty nine samples (33.33%) out of 117 were contaminated with duodenal contents. Duodenogastric reflux significantly (P<0.001) affected pH and volume of gastric in both groups C-1 vs C-2 and S-1 vs S-2. INTERPRETATION & CONCLUSION: Sodium rabeprazole 20 mg given orally a night before surgery provided adequate prophylaxis for acid aspiration syndrome at the time of induction of anaesthesia and duodeno-gastric reflux significantly affected both the pH and volume of gastric contents.

Rehydration with sodium-enriched coconut water after exercise-induced dehydration.

This crossover study assessed the effectiveness of plain water (PW), sports drink (SD), fresh young coconut water (CW) and sodium-enriched fresh young coconut water (SCW) on whole body rehydration (R) and plasma volume (PV) restoration after exercise-induced dehydration. Ten healthy male subjects ran at 65% of VO2max in an environmental temperature of 32.06 +/- 0.02 degree C with a relative humidity (rh) of 53.32 +/- 0.17% for 90 minutes to lose 3% body weight (BW). During the 2-hour rehydration period, subjects drank, in randomized order, PW, SD, CW or SCW equivalent to 120% of BW lost in three boluses representing 50, 40 and 30% of the fluid lost at 0, 30, and 60 minutes, respectively. In all trials subjects were still somewhat dehydrated even after the 2-hour rehydration period. Indexes of percent rehydration with PW, SD, CW and SCW were 58 +/- 2, 68 +/- 2, 65+/- 2 and 69 +/- 1%, respectively, with significantly better rehydration with SD and SCW. The rehydration indexes for SD and SCW were significantly lower than PW (p < 0.01). PV was restored to euhydration levels after 2 hours of rehydration with SD, CW and SCW but not with PW. The plasma glucose concentration were significantly higher when SD, CW and SCW were ingested. SCW was similar in sweetness to CW and SD but caused less nausea and stomach upset compared to SD and PW. In conclusion, ingesting SCW was as good as ingesting a commercial sports drink for whole body rehydration after exercise-induced dehydration but with better fluid tolerance.

Effects of sodium cyclamate on the rat placenta: a morphometric study

RESUMEN: El objetivo del trabajo fue determinar los efectos del ciclamato de sodio en la placenta de ratas, administrado durante el periodo de la embriogénesis. Fue administrado por vía intraperitoneal, en las ratas del grupo tratado, ciclamato de sodio en una dosis de 60 mg/Kg, desde el 10 al 14 día de gestación, siendo inyectado un volumen equivalente de solución salina en el grupo de ratas control. En el 20 día de preñez, 10 fetos (5 de cada grupo) fueron escogidos al azar para su estudio. Fue utilizada la técnica de cariometría para la evaluación de los parámetros nucleares de las células de las capas decidua, esponjosa y de las vellosidades coriónicas de la placenta de las ratas. El peso de los fetos tratados y de sus placentas fue menor que el del grupo control, así como también el funículo umbilical del grupo tratado fue más corto que el de los fetos controles. No hubo alteraciones en la capa de la decidua. En la capa esponjosa placentaria ocurrieron alteraciones de los siguientes parámetros: diámetro mayor, diámetro medio, perímetro, área, volumen, relación volumen/área y excentricidad. Los parámetros alterados en las vellosidades coriónicas fueron: diámetro medio, perímetro, área, volumen y relación volumen/área. El estudio demostró alteración placentaria con el uso del ciclamato de sodio en la rata preñada y su repercusión en el peso fetal y largo del funículo umbilical.

Valvopatia e gravidez / Aortic valve disease and pregnancy

Em nosso país, de 4 a 6% das gestantes apresentam algum tipo de doença cardiovascular. O alto percentual é atribuído à igualmente elevada incidência de doença reumática em mulher na idade fértil. Os riscos impostos pelas modificações hemodinâmicas da gravidez justificaram por muito tempo, a proibição da concepção em mulheres...

Las respuestas lentas a la angiotensina II, la activación de la proteína Src y del factor de crecimiento epidérmico en la génesis de la hipertensión esencial / Factors contributing to essential hypertension genesis

La hipertensión esencial es inducida por disfunción renal. Receptores normotensos de riñones de hipertensos desarrollan hipertensión y viceversa. La alteración renal más importante es el desacople del SRA respecto del nivel de sodio. El estrés oxidativo (ST-OX) es estimulado cuando los niveles de angiotensina II (Ang II) son inapropiados respecto del sodio corporal total. El ST-OX potencia el efecto vasoconstrictor de la Ang II por disminución del óxido nítrico (NO) y/o por incremento de los vasoconstrictores, como isoprostanos, ET1 y otros. Estos efectos se ponen de manifiesto en la ôrespuesta lenta a la Ang IIõ en la que la infusión en dosis pequeñas (subpresoras) induce retención de sodio y consecuente estímulo del STOX, con vasoconstricción. Estos efectos están mediados por señales intracelulares como la activación de proteína Src y del receptor del factor de crecimiento epidérmico por la Ang II, que parecen ser un mecanismo de vasoconstricción importante. Las especies reactivas de oxígeno inducidas por estos factores sostendrían una reacción autocatalítica, responsable de la producción sostenida de vasoconstrictores, con lo que se perpetúa la hipertensión.

Two Cases of Cerebral Salt Wasting Syndrome Developing after Cranial Vault Remodeling in Craniosynostosis Children

Hyponatremia has been recognized as an important postoperative metabolic complication after central nervous system (CNS) operations in children. If not appropriately treated, the postoperative hyponatremia can cause several types of CNS and circulatory disorders such as cerebral edema, increased intracranial pressure. The postoperative hyponatremia after CNS surgery has been considered as one of the underlying causes of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). In some cases, however, the cerebral salt wasting (CSW) syndrome has been detected. CSW syndrome is far less well-known than SIADH and also different from SIADH in diagnosis and treatment. It causes an increase in urine output and urine sodium after a trauma of CNS and dehydration symptoms. The appropriate treatment of CSW syndrome is opposite the usual treatment of hyponatremia caused by SIADH. The latter is treated with fluid restriction because of the increased level of free water and its dilutional effect causing hyponatremia, whereas the former is treated with fluid and sodium resuscitation because of the unusual loss of high urinary sodium. Early diagnosis and treatment of CSW syndrome after CNS surgery are, therefore, essential. We made a diagnosis of CSW syndrome in two craniosynostosis children manifesting postoperative hyponatremia and supplied them an appropriate amount of water and sodium via intravenous route. The hyponatremia or natricuresis of the children improved and neurologic and circulatory sequelae could be prevented.