Effect of Wei's triple nine needling on eye regulation in patients with presbyopia complicated with visual fatigue of liver depression and spleen deficiency / 中国针灸

OBJECTIVE@#To compare the clinical efficacy between Wei's triple nine needling combined with esculin and digitalis glycosides eye drops and esculin and digitalis glycosides eye drops alone for presbyopia complicated with visual fatigue of liver depression and spleen deficiency.@*METHODS@#Forty-six cases (92 eyes) with presbyopia complicated with visual fatigue of liver depression and spleen deficiency were randomly divided into an observation group (23 cases) and a control group (23 cases, 2 cases dropped off). The cases in the observation group were treated with Wei's triple nine needling and esculin and digitalis glycosides eye drops. The acupoints included Shangming (Extra), Chengqi (ST 1), Cuanzhu (BL 2) to Jingming (BL 1), Sizhukong (TE 23) to Taiyang (EX-HN 5), etc; the needling was given once every other day, three times a week, and the eye drops were given one drop each time, three times a day. The cases in the control group were only treated with the eye drops. Both groups were treated for 7 days as one course of treatment, and 2 courses of treatment were given. The visual fatigue core symptoms score, adjustment amplitude, adjustment lag and best average corrected visual acuity were observed in the two groups before treatment, 1 week and 2 weeks into treatment, respectively.@*RESULTS@#Compared before treatment, the visual fatigue core symptoms scores in the two groups were decreased after 1-week and 2-week treatment (P<0.05); in the observation group, the adjustment amplitude was increased after 2-week treatment (P<0.05), while in the control group, the adjustment amplitude was increased after 1-week and 2-week treatment (P<0.05); in the observation group, the adjustment lag was decreased after 1-week and 2-week treatment (P<0.05). After 2-week treatment, the visual fatigue core symptoms score in the observation group was lower than that in the control group, and the adjustment amplitude was higher than that in the control group (P<0.05). There were no significant differences in adjustment lag and best average corrected visual acuity between the two groups after 1-week and 2-week treatment (P>0.05).@*CONCLUSION@#Wei's triple nine needling combined with esculin and digitalis glycosides eye drops could improve the visual fatigue and eye regulation ability in patients with presbyopia complicated with visual fatigue of liver depression and spleen deficiency, and the effect is better than esculin and digitalis glycosides eye drops alone.

Aspectos novedosos de la intoxicación digitálica / New aspects on digitalis toxicity

Los digitálicos son fármacos con capacidad de aumentar la contractilidad miocárdica (inotrópico positivo), que han desempeñado un rol primordial en el tratamiento de pacientes con insuficiencia cardiaca; su uso inapropiado puede traer complicaciones serias a estos pacientes, incluso, hasta la muerte. La más importante de estas complicaciones es la intoxicación digitálica, originada por la sobredosis de dichos fármacos, a causa de la combinación del efecto inhibitorio en la conducción nodal y la estimulación sobre las fibras individuales auriculares y ventriculares. Debido al uso frecuente de estos medicamentos en todos los niveles de atención de salud y lo difícil que resulta diagnosticar dicha complicación por la complejidad de su cuadro clínico y de su expresión electrocardiográfica, se realizó una revisión bibliográfica exhaustiva sobre el tema para brindar amplia información, que permita una atención adecuada a los pacientes con este diagnóstico

Digitalis are drugs with the capacity of increasing myocardial contractility (inotropic positive agents) which have carried out an important role in the treatment of heart failure; their inappropriate use can bring severe complications to the patient, even, to death. The most important in these complications is the digitalis toxicity, originated by the overdose of these drugs, caused by the combination of the inhibitory effect in the nodal conduction and stimulation on the individual atrial and ventricular fibers. Due to the frequent use of these medications at all levels of medical care and to the difficulty in diagnosing this complication caused by the complexity of their clinical pattern and of their electrocardiographic expression, an exhaustive literature review was carried out on the topic to give a wide information that allows an appropriate care to the patients with this diagnosis

Conhecimento de um grupo de pacientes sobre medicamentos digitálicos por eles utilizados / Análisis del conocimiento de los pacientes sobre el uso de los medicamentos digitálicos / Analysis of patients' knowledge about the use of digitalis medicines

Este estudo teve como objetivo descrever o conhecimento dos pacientes que utilizam medicamentos digitálicos, no queconcerne ao nome, dose, frequência, horário, efeitos esperados e efeitos colaterais. Trata-se de um estudo quantitativodescritivo do qual participaram 25 pacientes de umhospital do interior do Estado de Minas Gerais, através de umquestionário estruturado. Destacou-se que 14 (56%)conhecem o nome do medicamento, com relação à dose,10 (40%) adesconhecem, 9 (36%) desconhecem a frequência, 13 (52%) desconhecem o horário, 18 (72%) desconhecem oefeitoesperado e 23 (92%) desconhecem os efeitos colaterais. Verificou-se escasso conhecimento acerca dos medicamentosdigitálicos, sendo de extrema necessidade que a equipe de enfermagem propicie aos pacientes em estudoaçõeseducativas.

This study aimed to describe knowledge of patientstaking digitalis medicines in relation to the name,dose, frequency,time, expected effects and side effects. It was conducted a descriptive-quantitative study by means ofa questionnaireadministered to 25 patients at a hospital in the State of Minas Gerais. It was found that 14 (56%) know the name of thedrug, 10 (40%) are unaware of the dose, 9 (36%) areunaware of the frequency, 13 (52%) are unaware ofthe time, 18 (72%)are unaware of the effect expected and 23 (92%) areunaware of the side effects. The limited knowledgeabout the drugdigitalis demonstrated the urgent need for the nursing staff to provide educational activities to patients.

Este estudio tuvo como objetivo describir el conocimiento de los pacientes que utilizan medicamentos digitálicos en loque concierne al nombre, dosis, frecuencia, horario, efectos esperados y efectos secundarios. Se realizó un estudiocuantitativo y descriptivo a través de un cuestionario aplicado a 25 pacientes de un hospital del interior del Estado deMinas Gerais. Se confirmó que 14 (56%) conocen el nombre del medicamento, 10 (40%) desconocen la dosis, 9 (36%)desconocen la frecuencia, 13 (52%) desconocen el horario, 18 (72%) desconocen el efecto esperado y 23(92%) desconocenlos efectos secundarios. El escaso conocimiento acerca de los medicamentos digitálicos mostró la extrema necesidad delequipo de enfermería de proporcionar a los pacientes en estudio acciones educativas.

A QSAR study on a series of simplified digitalis-like compounds acting on Na+,K+-ATPase

Among the cardiotonics (agents against congestive heart failure), the most important group is of the digitalis cardiac glycosides, but since these compounds suffer from a low therapeutic index, attention has been paid to investigating safer cardiotonic agents through the inhibition of Na+,K+-ATPase, the mechanism by which the digitalis cardiac glycosides elicit their action. Recently, a series of perhydroindenes were studied for their Na+,K+-ATPase inhibition activity. We report here a QSAR study on them to investigate the physicochemical and structural properties of the molecules that govern their activity in order to rationalize the structural modification to have more potent drugs. A multiple regression analysis reveals a significant correlation between the Na+,K+-ATPase inhibition activity of the compounds and Kier’s first order valence molecular connectivity index of their R5-substituents and some indicator parameters, suggesting that the R5-substituents of the compounds containing atoms with low valence and high saturation and the R1-substituents having =N−O− moiety will be conducive to the activity.

Role of cardiac biomarkers (troponin I and CK-MB) as predictors of quality of life and long-term outcome after cardiac surgery.

Perioperative and postoperative morbidity and mortality associated with cardiac surgery affect both the outcome and quality of life. Markers such as troponin effectively predict short-term outcome. In a prospective cohort study in a University Hospital we assessed the role of cardiac biomarkers, also as predictors of long-term outcome and life quality after cardiac surgery with a three-year follow-up after conventional heart surgery. Patients were interviewed via phone calls with a structured questionnaire examining general health, functional status, activities of daily living, perception of life quality and need for hospital readmission. Descriptive statistics and multivariate analysis were performed. Out of 252 consecutive patients, 8 (3.2%) died at the three years follow up: 7 for cardiac complications and 1 for cancer. Thirty-six patients (13.5%) had hospital readmission for cardiac causes (mostly for atrial fibrillation or other arrhythmias (9.3%), but none needed cardiac surgical reintervention; 21 patients (7.9%) were hospitalised for non-cardiac causes. No limitation in function activities of daily living was reported by most patients (94%), 92% perceived their general health as excellent, very good or good and none considered it insufficient; 80% were NYHA I, 17% NYHA II, 3% NYHA III and none NYHA IV. Multivariate analysis indicated preoperative treatment with digitalis or nitrates, and postoperative cardiac biomarkers release was independently associated to death. Elevated cardiac biomarker release and length of hospital stay were the only postoperative independent predictors of death in this study.

Comparação de diferentes metodologias para obtenção de cultura de calos de Stevia rebaudiana (Bertoni) Bertoni / Comparison of different methodologies for obtaining callus cultures from Stevia rebaudiana (Bertoni) Bertoni

As folhas de Stevia rebaudiana (Bertoni) Bertoni (Asteraceae) contêm glicosídeos diterpenóides (GDS), que são cerca de 300 vezes mais doce que a sacarose a 4%. O objetivo deste estudo foi avaliar a formação de calos, a partir de folhas obtidas in vivo e in vitro de S. rebaudiana em dois meios já descritos na literatura: Murashige e Skoog (MS), suplementado com 3 mg L-1 de ácido 2,4-diclorofenóxiacético (2,4-D), e o MS suplementado com 1 mg L-1 de ácido naftalenoacético (ANA) e 0,5 mg L-1 de 6-benzilaminopurina 6-BAP) e um desenvolvido em nosso laboratório o Woody Plant Medium (WPM), suplementado com 6 mg L-1 de ANA e 4 mg L-1 de cinetina (CIN). Os explantes obtidos in vitro iniciaram a formação de calos um pouco mais rapidamente que os das folhas de plantas advindas da natureza. A utilização dos nutrientes do meio WPM, associada a uma combinação de fitorreguladores adequada, proporcionou velocidade de indução e multiplicação de calos bem maiores que as apresentadas nos meios que empregaram os nutrientes do MS. Novos experimentos serão realizados, depois de alcançada a estabilidade genética dos calos, visando avaliar a capacidade destes em biossintetizar os GDS

The leaves from Stevia rebaudiana (Bertoni) Bertoni (Asteraceae) contain diterpenoid glycosides (GDS), which are almost 300 times sweeter than sucrose at 4%. The subject of this study was to evaluate the callus-formation from in vivo and in vitro leaves of Stevia rebaudiana in two already described in literature: Murashige and Skoog (MS) supplemented with 3 mg L-1 of 2,4-dichlorophenoxyacetic acid (2,4-D); MS supplemented with 1 mg L-1 of naphthaleneacetic acid (NAA) and 0.5 mg L-1 of 6-benzylaminopurine (6-BAP) and other developed in our laboratory the Woody Plant Medium (WPM) with 6 mg L-1 of NAA and 4 mg L-1 of Kinetin (KIN). The explants obtained in vitro initiated callus formation faster than leaves from natural plants. The utilization of WPM nutrients, associated with an adequate combination of phytoregulators, provided greater callus induction velocity and multiplication than the media that using MS nutrients. New experiments will be conducted after reaching genetic stability of the calluses, seeking to evaluate the capacity of these calluses to biosynthesize GDS

Fibrilación auricular / Atrial fibrillation

Atrial fibrillation is an arrhythmia characterized by no-coordinated atrial contraction that results in an inefficient atrial systole. The clinical classification of atrial fibrillation includes: ocassional, paroxysmal, persistent, and permanent. Multiple mechanisms have been described and accounts for a single ECG manifestation. Treatment should be individualized and has to considered several aspects including age, associated heart disease, and symptoms. Treatment strategies are: rhythm control, rate control, and thromboprophylaxis.

Las heparinas / Heparins

El presente artículo describe los diferentes tipos de heparina -no fraccionada, de bajo peso molecular- pentasacáridos-. Se detallan los mecanismos de acción vinculados a la hemostasia, los efectos adversos y las precauciones a considerar en el correcto manejo de las mismas

Tratamento medicamentoso da estenose aórtica / Medical treatment of aortic stenosis

A estenose aórtica importante deve implicar tratamento cirúrgico. Na evolução pré-cirúrgica deve-se avaliar a profilaxia da endocardite infecciosa e da doença reumática. Atualmente têm sido usadas estatinas para retardar a evolução da estenose aórtica. Medidas medicamentosas podem ser usadas para compensação do paciente, na preparação do tratamento cirúrgico, ou quando não há indicação deste. Entre as drogas usadas destacam-se os digitálicos e os diuréticos. O uso de vasodilatador pode ser justificado em grupo restrito de pacientes, como ponte para tratamento cirúrgico.

Estudio de la relación entre las características electromoleculares de los digitálicos y su acción farmacológica / Relationship between the electromolecular properties of digitalis compounds and their pharmacological properties

Pese a su reducido margen de seguridad, los digitálicos siguen utilizándose en el tratamiento de la insuficiencia cardiaca congestiva y la fibrilación auricular crónica. Con el descubrimiento de su estructura, se han realizado remodelaciones para disminuir su toxicidad. Investigaciones recientes reportan que la eficacia digitálica radica en la electronegatividad del anillo "D" esteroideo, generada por la lactona e hidroxilo que poseen estos compuestos. En el presente trabajo, damos cuenta de la importancia que tiene esta propiedad molecular, que aunada a la conformación estructural, dan lugar a cambios significativos en las propiedades farmacológicas como el inotropismo y el margen de seguridad. Así, evaluamos una serie de once compuestos derivados de digitoxigenina, con grupos que sustituyen sobre el anillo "D" al hidroxilo y/o la lactona, los cuales denominamos -OH, -Lac, D-01, D-02, D-03, D-07, D-14, D-15, D-20, D-21 y D-22. La electronegatividad y la energía conformacional de cada compuesto se determinaron por el método Duhamm. El estudio farmacológico se realizó en corazones aislados de cobayo con base en el modelo de Langendorff y, en corazón de perro conforme al modelo cardiopulmonar de Starling. Los resultados permiten observar que la modulación de la acción digitálica está centrada, estructuralmente, en los sustituyentes de la fracción "D". El efecto inotrópico positivo y el margen de seguridad, medido como el cociente de la dosis tóxica sobre la dosis inotrópica, están relacionados con el aumento de electronegatividad y con una disminución de las energías rotacional y translacional que definen la conformación molecular; en consecuencia, estas propiedades son imprescindibles en la eficacia digitálica.

In spite their reduced therapeutic index, digitalis-type drugs continue being used for treating diseases such as congestive heart failure and chronic atrial fibrillation. Thanks to the development of several methods, their structural determination has been feasible, so, structural modifications have been worked out to modulate their toxicity. Several reports realizes that efficacy for these digitalis-type drugs lies on the electronegativity centered on the steroidal moiety (D-ring) generated by either lactone and hydroxyl sub-stituents attached to the steroidal moiety. In this work, we report how electronegativity, and so structural conformation, does modify their pharmacological properties, e.g., inotropism and safety margin. Thus, we evaluated a series of eleven drugs derived from digitoxigenin, named -OH, -Lac, D-01, D-02, D-03, D-07, D-14, D-15, D-20, D-21 and D-22, with groups that substitute both lactone and hydroxyl groups on the steroidal D-ring. Electronegativity and conformational energy were determined by Duhamm's method. The pharmacological evaluation for these drugs was accomplished in guinea pigs isolated hearts (according to the model proposed by Langendorff) and dog's isolated heart (as established by Starling's in vivo model). The results may suggest that digitalis-like action lies on the substituents attached to the D-ring. Positive inotropic effect and therapeutic index are related with increases in electronegativity as well with decreases in rotational and traslational energies; therefore, these molecular properties have such importance for the digitalis efficacy. (Arch Cardiol Mex 2003; 73:11-17).

Tratamento ambulatorial da insuficiência cardíaca / Ambulatorial treatment of heart failure

Atualmente, a insuficiência cardíaca constitui um problema clínico de grande importância, devido à gravidade de suas manifestações e à sua alta prevalência. O diagnóstico da causa da insuficiência cardíaca e o reconhecimento dos fatores que podem ser responsáveis pela descompensaçäo dos pacientes säo importantes para o tratamento da doença. A terapêutica farmacológica deve ser dirigida, principalmente, para promover o bloqueio da ativaçäo neuro-hormonal que ocorre nesta condiçäo. Assim, inibidores da enzima conversora da angiotensina, betabloqueadores e antagonistas da aldosterona säo utilizados rotineiramente. Digitálicos e diuréticos devem ser prescritos como coadjuvantes no controle dos sinais e sintomas da insuficiência cardíaca

Acerca de la terapéutica digitálica. Bosquejo histórico / On digatalic therapy

La acción de medicamentos derivados de muchas especies vegetales ha siempre despertado el más vivo interés de naturalistas y médicos. Además, en todas las épocas, se ha exigido un buen conocimiento de la botánica médica de parte de quienes se destinaban a ejercer la medicina. Entre las plantas medicinales utilizadas por los antiguos pueblos del Anáhuac, se cita el yoloxóchitl o flor del corazón (Talauma mexicana) que, al parecer, tiene acción simildigitálica. Investigaciones de nuestro siglo han demostrado un efecto inotrópico positivo y bradicardizante del extracto de Magnolia grandiflora o Talauma mexicana. Desde fines del siglo XVIII se ha utilizado la digital, considerada inicialmente como un diurético y después como un cardiotónico. La acción de los glucósidos digitálicos sobre los tejidos cardiácos ha sido estudiada experimentalmente sobre todo en México. Hoy en día existen agentes inotrópicos positivos derivados de las piridinas, como la milrinona, que se emplean útilmente en la insuficiencia cardiaca refractaria. Pero, según la opinión de distinguidos farmacólogos, ® en el caso de le insuficiencia cardiaca asociada a fibrilación auricular, la digital resulta insustituible".

Manejo de la intoxicación por digitálicos / Management of digitalic intoxication

La intoxicación por digitálicos en pediatría es poco frecuente, pero sus manifestaciones y complicaciones ponen en riesgo la vida del paciente, por lo que es fundamental un diagnóstico precoz y un manejo adecuado. Es importante destacar que el espectro de pacientes en que se presenta es muy variado, desde niños que accidentalmente ingieren este medicamento, hasta pacientes cardiópatas con ingesta crónica de estos medicamentos. En estos últimos, dado el estrecho margen terapéutico y condiciones propias del paciente, pueden tener manifestaciones de toxicidad aun en las dosis recomendadas