El "chaco": arcilla medicinal comestible del altiplano peruano y sus propiedades en la patología digestiva / The "Chaco": eatable medicinal clay in the Peruvian highlands and his properties in digestive diseases

Los pobladores del altiplano peruano-boliviano consumen una sustancia natural conocida como "chaco", muy difundida desde la época precolombina y apreciada por sus propiedades digestivas. El Chaco es una arcilla medicinal comestible que es usada en forma de suspensión con agua para cohibir molestias dispépticas o manifestaciones ácido-pépticas. En esta contribución damos a conocer aspectos físico-químicos de la composición del Chaco, estudios experimentales en animales que evalúan su efecto antiulceroso y una prueba in vitro que estudia su propiedad antiácida. El mecanismo de acción terapéutico propuesto se debe a una acción citoprotectora sobre la mucosa gástrica por mecanismos independientes de la inhibición de la secreción ácida, ya que no posee propiedad antiácida in vitro. Además tiene una capacidad de adsorción a distintas moléculas orgánicas debido a su gran superficie externa y carga tetraédrica que hace que interaccione con sustancias polares como el agua y toxinas. El otro propósito de esta contribución especial, es reconocer la coexistencia de la "Medicina Tradicional" y la "Medicina Occidental", situación que conlleva a la necesidad de la investigación preclínica de diversos recursos naturales.

The inhabitants of the peruvian-bolivian plateau consume a natural substance known as "Chaco", widespread since pre-Columbian era and appreciated for its digestive properties. The Chaco is an edible medicinal clay that is used as slurry with water to restrain dyspeptic discomfort or acid-peptic manifestations. In this contribution we present physicochemical aspects of the composition of the Chaco, experimental animal studies that evaluate its antiulcer effect and in vitro test that studies the antacid property. The proposed mechanism of therapeutic action is due to a cytoprotective effect on the gastric mucosa by independent mechanisms of acid secretion inhibition, as it has no antacid property in vitro. Also it has an adsorptivity to different organic molecules due to their large surface area and tetrahedral charge that makes it to interact with polar substances such as water and toxins. The other purpose of this special contribution is to recognize the coexistence of "Traditional Medicine" and "Western Medicine", a situation which leads to the need for preclinical research of various natural resources.

Correlación de valores de TTPa con anti factor Xa para establecer rango terapéutico en tratamiento anticoagulante con heparina sódica / Correlation between aPTT and antifactor Xa to determine therapeutic ranges for unfractionated heparin

Background: The therapeutic range (TR) of activated partial thromboplastin time (aPTT) for unfractionated heparin (UFH) dosing was established in the 1970 decade. Since then aPTT determination has changed. Current TR may be sub or supra-therapeutic depending on the reagents of the test, and therefore, responsible for complications of therapy. Aim: To establish the TR for UFH dosing in our institution using antifactor Xa analysis as reference standard. Material and Methods: After obtaining an informed consent, 43 blood samples were obtained for aPTT determination and antifactor Xa assay in 23 patients treated with intravenous UFH. Samples were processed at Emergency and Hemostasis Labs. We excluded patients receiving other anticoagulants, with thrombophilia, pregnancy or liver disease. Results: Mean aPTT values in the Hemostasis and Emergency labs ​​were 57.1 ± 18.9 and 56.6 ± 18.3 seconds, respectively (p = 0.77). The squared correlation coefficients between aPTT and antifactor Xa at hemostasis and emergency labs were R2 0.5 and 0.45 respectively, p < 0.001. Using a linear regression analysis, therapeutic aPTT range values ​​in our laboratory were established between 50 and 80 seconds, corresponding to antifactor Xa values of 0.3 to 0.7 IU/mL. Conclusions: According to current recommendations, validation of aPTT determination with reference techniques should be done in every institution.

Adequação de um sistema de hemodiálise em eqüinos / Adequacy of hemodialysis system in horses

Realizou-se a adequação da técnica de hemodiálise com eqüinos, distribuídos em quatro grupos experimentais de seis animais cada. Os animais do grupo I foram submetidos a cateterismo central unilateral (grupo-controle); os do grupo II foram submetidos a cateterismo central unilateral com cateter duplo-lúmen e a uma sessão de hemodiálise de seis horas; os do grupo III a cateterismo central unilateral com cateter duplo-lúmen e duas sessões de hemodiálise de seis horas e os do grupo IV a cateterismo central bilateral com cateter monolúmen e a uma sessão de hemodiálise de seis horas. Empregaram-se xilazina 10 por cento (0,4mg/kg) e acepromazina 2 por cento (0,008mg/kg) via intravenosa para sedação. Foram utilizados dois hemodialisadores conectados em série, do tipo fibras ocas, baixo fluxo, membrana de polissulfona e área de 1,8m². O fluxo sangüíneo médio foi de 319,18±97,41ml/minuto, associado a um fluxo de dialisato de 500ml/min. A anticoagulação foi feita com heparina sódica em 100UI/kg para primming, repetida na dose de 53,86±18,61UI/kg/hora. Foram avaliados: tempo de coagulação, tempo de protrombina, tempo de tromboplastina parcial ativada e contagem plaquetária, e verificado trombocitopenia nos grupos dialisados. O melhor acesso vascular foi proporcionado pelo cateterismo unilateral com cateter lúmen-duplo (Grupos II e III), podendo a técnica de hemodiálise ser empregada na espécie eqüina, com dialisadores de alta eficiência, em sessão de seis horas de diálise.

Hemodialysis adequacy was studied in four groups with six horses in each: the treatments: group I animals were submitted to unilateral central venous catheter (control group); group II animals were submitted to unilateral central venous double lumen catheter and one six-hour session of hemodialysis; group III horses were submitted to unilateral central venous double lumen catheter and to two six-hour session of hemodialysis, and group IV horses were submitted to bilateral central venous mono lumen catheter and to one six-hour session of hemodialysis. Xilazine 10 percent (0.4mg/kg) and acepromazine 2 percent (0.008 mg/kg) were iv administrated for sedation. Two hollow fiber, 1.8m² low flux polyssulfone hemodialysis apparatus were used in a connected serie. The mean blood flux was 319.18±97.41ml/min with a dialisate flux of 500ml/min. Anticoagulation was performed with sodium heparin, 100UI/kg for priming at the dose of 53.86±18.61UI/kg/h. Anticoagulation monitoring was performed by clotting time, protrombin time, tromboplastin activated time, and platelet number. Decrease in platelet number was detected in groups submitted to dialysis. The best vascular access was performed with double lumen catheter and the hemodialysis may be used in equine practice, with high performance dialyze used in six- hour session.

Effect of implementing nursing guidelines on occurrence of deep venous thrombosis for critically iLL patients

Deep venous thrombosis [DVT] is a major health problem that results in significant morbidity and mortality for the critically ill patients in the critical care units. It was documented that DVT occurs in about two million Americans each year, whereas pulmonary embolism [PE] as a complication of DVT causes approximately 50.000 to 60.000 deaths. Moreover, it was revealed by a study done in Assuit University Hospital that out of 220 surgical patients, 12[5%] died with pulmonary embolism as a complication of DVT. Other research done at Alexandria University in El-Hadra Hospital on 50 orthopedic patients revealed that seven patients were detected with DVT, The critical care nurses are the key players in the prevention of DVT and its complications. They are in the ideal position to asses patient risk factors early and ask for DVT prophylaxis. The current study was carried out to evaluate the effect of implementing nursing guidelines on the occurrence of DVT for critically ill patients. Four critical care unites were used to collect the data for this study at Assuit University Hospital, sixty critically ill patients were included in this study, they were divided into two groups G1 [control group] and G2 [interventional group] 30 patients each. Two tools were used to collect the data of this study. Tool one: "Patient's assessment for DVT, and Tool two: the "DVT evaluation sheet". Findings of the current study revealed low incidence of DVT for the global sample, only two patients experienced DVT in the control group, and none of the interventional group experienced DVT. Moreover, it was observed that the preventive measures of DVT done by the critical care nurses for the control group using non-pharmacological and mechanical methods were not adequately performed. In addition, it was found that all the studied patients of control group did not wear the elastic stocking, while small proportion of this group performed leg exercises, changed their position, did deep breathing, and coughing exercises, and transfer on the chair. It was observed that most of the studied patients experienced low percent of DVT manifestations with no statistical significant difference between the both groups. The present study revealed also that nearly half of the studied patients were in moderate and high risk grades for DVT in the both groups. Based on the current study findings it can be recommended that this research should be repeated on a large sample size and in multi centers for generalization. Moreover, training programs should be established to update critical care nurses' knowledge and skills about DVT preventive measures, and how to use the technical skills to assess the occurrence of DVT using the evidence base nursing and medicine

Study of some haemostatic and inflammatory parameters in preeclamptic and normotensive pregnant females

Preeclampsia is an idiopathic multisystem disorder specific to human pregnancy characterized by gestational hypertension and proteinuria. It complicates many pregnancies and is the third common cause of maternal and neonatal mortality and morbidity. The aim of the present work was to elucidate the relationship between serum maternal levels of C-reactive protein [CRP] as an inflammatory marker and coagulation and fibrinolysis as haemostatic markers in preeclamptic and normotensive pregnant females compared to non-pregnant females. Sixty females were enrolled in the study divided into ten non pregnant healthy females as the control group [Group I], twenty five normotensive pregnant females [Group II], twenty five preeclamptic pregnant females [Group III]. The pregnant females all were primigravidae, in the third trimester of pregnancy. For all these females C-reactive protein was measured as an inflammatory marker. Haemostatic parameters included platelet count, prothrombin time, activated partial thromboplastin time and thrombin time as coagulation parameters while fibrinolytic parameter included euglobulin clot lysis time. The results showed a significant negative correlation between CRP and platelet count in preeclamptic group. It also showed a higher positive correlation between CRP and Euglobulin Clot Lysis Time [fibrinolysis parameter] in preeclampsia than in the normotensive and control groups

Multimeric analysis in diagnosis of vWD variants in Indians.

von Willebrand disease is a common inherited bleeding disorder and the problem is undefined in developing countries due to limitation of its diagnostic facilities. The aim of the study was to diagnose vWD in patients with history of muco - cutaneous bleeding and characterization into its variants by multimeric analysis. 224 patients presenting with history of muco - cutaneous bleeding were selected. In all patients, platelet count, BT, PT, APTT, PF3 availability, clot solubility and factor VIII assay were done. Diagnosis of vWD was confirmed by RIPA, vWF: Ag, and vWF: RCo and its sub-characterization was done by multimeric analysis. 64 patients were diagnosed to have vWD. Of these, 21.9% were of type 1 vWD, 43.7% type 2 vWD, 1.6% acquired vWD and 32.8% type 3 vWD. By multimeric analysis, 2 patients had supranormal HMW multimers and two patients had normal distribution of vWF multimers were diagnosed as type 2M 'Vicenza'; and type 2M vWD respectively. It is concluded, that vWD is not an uncommon condition amongst Indian population.

Avaliação do desempenho dos reagentes do tempo de tromboplastina parcial ativada utilizados para detectar o anticoagulante lúpico / Assessment of the performance of reagents of activated partial thromboplastin time used to detect the lupus anticoagulant

INTRODUÇAO: O anticoagulante lúpico é uma imunoglobulina pertencente à família dos anticorpos antifosfolípides. A sua ação in vitro é interferir nos testes de coagulação dependentes de fosfolípides. O tempo de tromboplastina parcial ativada (TTPA) é um teste utilizado como screening na pesquisa do anticoagulante lúpico. Os reagentes utilizados neste teste apresentam grandes variações quanto à sensibilidade. OBJETIVO: Avaliar o desempenho dos reagentes do TTPA e detectar a presença do anticoagulante lúpico através de diferentes testes da coagulação. MATERIAL E MÉTODO: A pesquisa do anticoagulante lúpico foi realizada em 50 amostras plasmáticas de pacientes do sexo feminino através dos testes do TTPA, do tempo de coagulação do caulim (TCC), do tempo de tromboplastina parcial ativada diluída (TTPAd) e do tempo do veneno da víbora de Russel diluído (TVVRd). Três cefalinas comerciais foram avaliadas pelos testes do TTPA e do TTPAd. Na comparação entre os reagentes estudados foi aplicado o cálculo do intervalo de confiança (95 por cento). RESULTADOS: Os três reagentes avaliados apresentaram boa concordância e os métodos utilizados responderam bem à pesquisa do anticoagulante lúpico. DISCUSSAO E CONCLUSAO: As três cefalinas comerciais avaliadas podem ser utilizadas na rotina laboratorial para a pesquisa do anticoagulante lúpico.