Quality of Life Score as a Predictor of Death in Dogs with Degenerative Mitral Valve Disease / Escore de Qualidade de Vida como Preditor de Mortalidade em Cães com Doença Degenerativa da Valva Mitral

Abstract Background: The knowledge of the variables predicting mortality is important in clinical practice and for therapeutic monitoring in mitral valve disease. Objectives: To determine whether a quality of life score evaluated with the Functional Evaluation of Cardiac Health questionnaire would predict mortality in dogs with degenerative mitral valve disease (DMVD). Methods: Thirty-six client-owned dogs with mitral valve disease underwent clinical, laboratory, and echocardiographic evaluations at baseline and were monitored for 6 months. Cardiovascular death was the primary outcome. Results: The 36 dogs were classified as survivors or nonsurvivors. Higher values of the following variables were obtained at baseline in the nonsurviving group (12 dogs): amino-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, plasma norepinephrine, heart rate, quality of life score, diastolic left ventricular internal dimension to aortic root ratio, systolic left ventricular internal dimension to aortic root ratio, and left atrium to aortic root ratio. NT-proBNP levels and quality life score were independently associated with death in the multivariable analysis. Conclusion: The quality life score was an independent variable for cardiac death in dogs with DMVD. This result is encouraging, as this score is easy to apply and does not require any technology, only a veterinarian and an observant owner.

Resumo Fundamento: O conhecimento das variáveis preditoras de mortalidade é importante para a prática clínica e para o acompanhamento terapêutico na doença da valva mitral. Objetivos: Determinar se um escore de qualidade de vida avaliado com o Functional Evaluation of Cardiac Health poderia auxiliar na predição de mortalidade em cães com doença degenerativa da valva mitral (DDVM). Métodos: Trinta e seis cães de estimação com doença valvar mitral foram submetidos a avaliação clínica, laboratorial e ecocardiográfica no início do estudo e monitorizados durante 6 meses. A morte cardiovascular foi o desfecho primário. Resultados: Os 36 cães foram classificados como sobreviventes ou não sobreviventes. Os valores mais elevados das seguintes variáveis foram obtidos no início do estudo no grupo de não sobreviventes (12 cães): fragmento N-terminal do peptídeo natriurético tipo B (NT-proBNP), norepinefrina plasmática, frequência cardíaca, escore de qualidade de vida, razão da dimensão interna diastólica do ventrículo esquerdo e raiz aórtica, razão da dimensão interna sistólica do ventrículo esquerdo e raiz aórtica e a relação da dimensão do átrio esquerdo e a raiz aórtica. Concentrações de NT-proBNP e o escore de qualidade de vida foram independentemente associados com morte na análise multivariada. Conclusão: O escore de qualidade de vida foi uma variável independente para a morte por doença cardíaca em cães com DDVM. Este resultado é encorajador, pois este escore é de fácil aplicação e não requer o emprego de tecnologia, necessitando apenas de um veterinário e um dono observador.

Relationship of cortisol, norepinephrine, and epinephrine levels with war-induced posttraumatic stress disorder in fathers and their offspring

Objective: To compare afternoon serum/plasma levels of hormones in four groups: (A) veterans with posttraumatic stress disorder (PTSD), (B) offspring of PTSD veterans, (C) veterans without PTSD, and (D) offspring of non-PTSD veterans. Methods: Evaluation consisted of a semi-structured interview for axis I and II diagnoses, followed by measurement of afternoon serum cortisol and plasma epinephrine and norepinephrine by ELISA (Diametra) and LND (LDN Labor Diagnostika Nord GmbH & Co. KG) respectively. Data were analyzed using descriptive statistics and the Student t, Kolmogorov-Smirnov, and nonparametric Mann-Whitney tests. Results: One hundred and sixty-eight volunteers were investigated across the four groups. The groups were similar in terms of demographic characteristics, war experience and traumatization, and psychiatric and medical conditions other than PTSD (group A was similar to group C and group B was similar to group D). Between-groups comparisons did not yield statistically significant differences. Post-hoc analyses revealed significant differences in afternoon cortisol level between the offspring of veterans with current/past history of PTSD and the offspring of veterans without a history of PTSD. Conclusion: We only found decreased cortisol levels in offspring of veterans after rearranging the groups to reflect previous history of PTSD. Further studies are required to investigate the relationship between cortisol levels and the transgenerational effects of trauma and parental PTSD. .

Pressão arterial, respostas metabólicas e autonômicas à insulina e infusão de intralipid® em pacientes chagásicos / Blood pressure, metabolic and autonomic responses to insulin and intralipid® infusion in chagasic patients / Presión arterial, respuestas metabólicas y autonómicas a la insulina e infusión de intralipid® en pacientes chagásicos

FUNDAMENTO: Infusão de intralipid e heparina resulta em aumento da pressão arterial e também em anormalidades autonômicas em indivíduos normais e hipertensos. OBJETIVO: Avaliar a sensibilidade a insulina e o impacto da infusão de intralipid e de heparina (ILH) sobre a resposta hemodinâmica, metabólica e autonômica em pacientes com a forma indeterminada da doença de Chagas. MÉTODOS: Doze pacientes com a forma indeterminada da doença de Chagas e 12 voluntários saudáveis foram avaliados. RESULTADOS: A pressão arterial basal e a frequência cardíaca foram semelhantes nos dois grupos. Os níveis plasmáticos de noradrenalina encontravam-se ligeiramente aumentados no grupo de pacientes chagásicos. Após o Teste de Tolerância a Insulina (TTI), houve um declínio significativo na glicose dos dois grupos. A Infusão de ILH resultou em aumento da pressão arterial em ambos os grupos, mas não houve nenhuma mudança significativa na noradrenalina plasmática. O componente de Baixa Frequência (BF) mostrou-se semelhante e aumentou de forma semelhante em ambos os grupos. O componente de Alta Frequência (AF) apresentou-se menor no grupo chagásico. CONCLUSÃO: Pacientes com forma indeterminada da doença de Chagas apresentaram aumento da atividade simpática no momento basal e uma resposta inadequada à insulina. Eles também tiveram um menor componente de alta frequência e sensibilidade barorreflexa prejudicada no momento basal e durante a infusão de intralipid e heparina.

BACKGROUND: Intralipid and heparin infusion results in increased blood pressure and autonomic abnormalities in normal and hypertensive individuals. OBJECTIVE: To evaluate insulin sensitivity and the impact of Intralipid and heparin (ILH) infusion on hemodynamic, metabolic, and autonomic response in patients with the indeterminate form of Chagas' disease. METHODS: Twelve patients with the indeterminate form of Chagas' disease and 12 healthy volunteers were evaluated. RESULTS: Baseline blood pressure and heart rate were similar in both groups. Plasma noradrenaline levels were slightly increased in the Chagas' group. After insulin tolerance testing (ITT), a significant decline was noted in glucose in both groups. ILH infusion resulted in increased blood pressure in both groups, but there was no significant change in plasma noradrenaline. The low-frequency component (LF) was similar and similarly increased in both groups. The high-frequency component (HF) was lower in the Chagas' group. CONCLUSION: Patients with the indeterminate form of Chagas' disease had increased sympathetic activity at baseline and impaired response to insulin. They also had a lower high-frequency component and impaired baroreflex sensitivity at baseline and during Intralipid and heparin infusion.

FUNDAMENTO: La Infusión de intralipid® y de heparina trae como resultado un aumento de la presión arterial y también de las anormalidades autonómicas en los individuos normales e hipertensos. OBJETIVO: Evaluar la sensibilidad a la insulina y el impacto de la infusión de intralipid® y de heparina (ILH) sobre la respuesta hemodinámica, metabólica y autonómica en pacientes con la forma indefinida de la Enfermedad de Chagas. MÉTODOS: Fueron evaluados doce pacientes con la forma indefinida de la Enfermedad de Chagas y 12 voluntarios sanos. RESULTADOS: La presión arterial basal y la frecuencia cardíaca fueron similares en los dos grupos. Los niveles plasmáticos de noradrenalina estaban ligeramente más elevados en el grupo de pacientes chagásicos. Después del Test de Tolerancia a la Insulina (TTI), se produjo una ostensible disminución en la glucosa de los dos grupos. La Infusión de ILH trajo como consecuencia el aumento de la presión arterial en ambos grupos, pero no hubo ningún cambio significativo en la noradrenalina plasmática. El componente de Baja Frecuencia (BF), fue similar y aumentó de forma parecida en ambos grupos. El componente de Alta Frecuencia (AF) se presentó con un menor nivel en el grupo chagásico. CONCLUSIONES: Los pacientes con una forma indeterminada de la Enfermedad de Chagas, presentaron un aumento en la actividad simpática al momento basal y una respuesta inadecuada a la insulina. También tuvieron un menor componente de alta frecuencia y de sensibilidad barorrefleja, que fue perjudicado en el momento basal y durante la infusión de intralipid® y heparina.

Altered secretory activity in rat adrenal chromaffin cells after experimentally induced bronchial asthma and dexamethasone treatment: ultrastrucutral and biochemical study

It is generally accepted that chromaffin cells release their contents by both exocytosis and piecemeal degranulaltion [PMD]. Bronchial asthma and dexamethasone treatment might after this secretory activity. This study was designed to shed light on secretory activity in the normal adult rate chromaffin cells, in rats subjected to bronchial asthma and after treatment with dexamethasone. Rats were divided into three equal groups at random:group A[control], group B [asthmatic rats], and group C [dexamethasone-treated asthmatic rats]. In rats of group B, the chronic asthma model was established by an intraperitoneal injection and challenge with ovalbumin. In group C, the rats were pretreated with dexamethasone before each challenge. Serum epinephrine and norepinephrine levels were measured by enzyme-linked immunosorbent assay. Bronchoalveolar lavage fluid was examined for the total leukocytic count and paraffin sections from the lung were stained with H and E. Specimens of the adrenal medulla were examined by transmission electron microscope and were morphometrically analyzed. Significant decreases in serum epinephrine and norepinephrine levels were recorded in asthmatic rats and corrected after dexamethasone treatment. The total numbers of adrenaline and noradrenaline granules were significantly lower in asthmatic rats. Features of PMD manifested as tail-like projections, altered granules with eroded contents, partially empty granules, large completely empty containers, and small cytoplasmic vesicles were observed in control rats and were augmented in rats subjected to chronic asthma. Augmented features of PMD and biochemical changes in the conditions of chronic asthma could be corrected by dexamethasone treatment

The Effects of Heat and Massage Application on Autonomic Nervous System

PURPOSE: The objective of this study is to evaluate the effects of heat and massage application on autonomic nervous system. MATERIALS AND METHODS: One hundred thirty-nine subjects volunteered and completed this study. Heat and massage was daily applied for 40 minutes, 5 days a week for 2 weeks. Primary-dependent measures included heart rate variability, sympathetic skin response, and serum cortisol and norepinephrine levels. RESULTS: Serum cortisol levels were significantly decreased at 2 weeks compared to baseline (p=0.003). Plasma norepinephrine levels at 4 weeks were significantly decreased compared to baseline (p=0.010). Heart rate, using the power spectra, increased significantly after 2 weeks compared to baseline. Of autonomic nerve conduction measures, latency was significantly increased at 2 and 4 weeks compared to baseline (p=0.023, 0.012), and amplitude was significantly decreased at 4 weeks compared to baseline (p=0.008). There were no serious adverse events such as burns or other major complications. CONCLUSION: The results of this study suggest that heat and massage applications provide relaxation to the autonomic nervous system without serious adverse events.

Case Study of Hepatic Radiofrequency Ablation Causing a Systemic Inflammatory Response Under Total Intravenous Anesthesia

OBJECTIVE: To investigate the effects of hepatic radiofrequency ablation (RFA) in patients with malignant liver disease with respect to inflammation activation and stress response. MATERIALS AND METHODS: In an observational trial, we investigated the physiologic parameters of 17 patients (20 interventions) who underwent percutaneous RFA under general anesthesia after applying total intravenous anesthesia. TNFalpha, IL-6, IL-8, IL-10, adrenaline and noradrenaline, liver enzymes, lactate and creatine kinase were determined pre-interventionally after induction of anesthesia (T1), 90 minutes after initiation of RFA (T2), immediately after the conclusion of the procedure (T3), and 24 hours after the procedure (T4). RESULTS: A significant increase in body temperature (p < 0.001), and mean arterial pressure (p = 0.001) were measured intraoperatively (T2) and the day after the procedure (T4). Increased levels of IL-6 were measured at T3 and T4 (p = 0.001). IL-10 increased immediately after the procedure (T3; p = 0.007). IL-6 levels correlated well with the total energy applied (r = 0.837). Significant increases in the levels of adrenaline and noradrenaline were present at T3 and T4 (p < 0.001). The RFA-induced destruction of hepatic tissue was associated with increased levels of AST, ALT, GLDH and LDH. CONCLUSION: Percutaneous RFA of hepatic malignancies causes an inflammatory and endocrine activation, similar to the systemic inflammatory response syndrome. These effects have to be taken in account when dealing with patients susceptible to sepsis or multi-organ failure.

Norepinephrine remains increased in the six-minute walking test after heart transplantation

OBJECTIVE: We sought to evaluate the neurohormonal activity in heart transplant recipients and compare it with that in heart failure patients and healthy subjects during rest and just after a 6-minute walking test. INTRODUCTION: Despite the improvements in quality of life and survival provided by heart transplantation, the neurohormonal profile is poorly described. METHODS: Twenty heart transplantation (18 men, 49±11 years and 8.5±3.3 years after transplantation), 11 heart failure (8 men, 43±10 years), and 7 healthy subjects (5 men 39±8 years) were included in this study. Blood samples were collected immediately before and during the last minute of the exercise. RESULTS: During rest, patients' norepinephrine plasma level (659±225 pg/mL) was higher in heart transplant recipients (463±167 pg/mL) and heathy subjects (512±132), p<0.05. Heart transplant recipient's norepinephrine plasma level was not different than that of healthy subjects. Just after the 6-minute walking test, the heart transplant recipient's norepinephrine plasma level (1248±692 pg/mL) was not different from that of heart failure patients (1174±653 pg/mL). Both these groups had a higher level than healthy subjects had (545±95 pg/mL), p<0.05. CONCLUSION: Neurohormonal activity remains increased after the 6-minute walking test after heart transplantation.

Influence of sympathetic activity on the progression of chronic kidney disease

There is clear evidence that chronic kidney disease [CKD] is often characterized by the presence of sympathetic hyperactivity. Data accumulating that this sympathetic hyperactivity is indeed important, because it may influence cardiovascular and renal prognosis. The aim of this study was to assess the relationship between glomerular filtration rate [GFR] and the levels of norepinephrine [NE] in serum and urine in the presence of variable degrees of renal functional impairment. A total of 75 CKD patients were divided into 5 groups according to GFR, group 1: 15 CKD patients with GFR>90ml/min/1.73m2 [stage 1CKD]. group 2: 15 CKD patients with GFR 60-89ml/min/1.73m2 [stage 2 CKD]. group 3: 15 CKD patients with GFR 30-59ml/min/1.73m2 [stage 3 CKD]. group 4: 15 CKD patients with GFR 15-29ml/min/1.73m2[stage 4 CKD]. group 5: 15 CKD patients with GFR<15ml/min/1.73m2 [stage 5, endstage renal failure], in addition to 15 healthy controls were studied. GFR was estimated by Cockroft-Gault formula. Norepinephrine was measured by an enzyme-linked immunosorbent assay. In addition, blood urea, serum creatinine, C-reactive protein [C-RP], fasting blood sugar [PBS], serum total cholesterol, triglycerides and 24-h urinary proteins were performed. Compared with controls, CKD patients had higher levels of serum norepinephrine, urinary norepinephrine was significantly lower among CKD patients. When GFR was reduced in CKD patients, serum norepinephrine was elevated and urinary norepinephrine was reduced suggesting greater renal impairment. In multivariate correlation, GFR were negatively correlated with serum norepinephrine and positively correlated with urinary norepinephrine. Serum norepinephrine levels were increased and urinary norepinephrine excretion were decreased in CKD patients, and may be one of the aggrevating factors for deterioration of renal function in those patients

Influence of isotretinoin treatment on monoamines in different brain areas of male rats

Despite widespread use of isotretinoin for its anti-acne effects and its current evaluation in clinical trials as a cancer treatment, little is known about its effect on brain function and neuronal pathways in adult animals, particularly after oral administration which mimics the human route. Here, adult male rats were gavaged daily with olive oil and 1.5mg/kg/day isotretinoin for 4 weeks during which body weight was measured and changes in food intake and locomotor activity were observed. After decapitation, the concentrations of dopamine [DA], norepinephrine [NE], serotonin [5-HT] and 5-hydroxyindoleacetic acid [5-HIAA] were measured in different brain areas of rats after 2 and 4 weeks of repeated injection. The results show that, following isotretinoin administration body weight, food intake and locomotor activity were generally decreased. Treatment with isotretinoin produced marked increases in the concentrations of DA and 5-HIAA after 2 and 4 weeks and of NE after 4 weeks in the various brain regions examined. However, level of 5-HT was significantly decreased in most of the brain areas studied after 2 and 4 weeks following isotretinoin treatment. The results also show that all of these effects induced by isotretinoin treatment were tended to resolve within one week of drug cessation. It is possible to conclude that such alteration in monoamine systems could contribute to the isotretinoin induced increase in depression related behavior

Associations between Sympathetic Activity, Plasma Concentrations of Renin, Aldosterone, and Parathyroid Hormone, and the Degree of Intractability of Blood Pressure Control in modialysis Patients

This study was designed to examine how such factors as hemodialysis parameters, body mass index, renin and aldosterone concentrations, sympathetic nervous activity, and parathyroid hormone concentrations are associated with the control of hypertension in hemodialysis patients. Hemodialysis patients (n=114) were grouped into four categories. Group 1 had normal BP without antihypertensive medication. Group 2 needed one antihypertensive drug, Group 3 needed combination of two or three categories of antihypertensive drugs without minoxidil. Group 4 needed more than three categories of antihypertensive drugs including minoxidil. Parathyroid hormone, beta2-microglobulin, renin and aldosterone, epinephrine, norepinephrine, and hemodialysis parameters were measured. The fractional clearance of urea as Kt/V urea was significantly lower in Group 3 and Group 4 than in Group 2 (p<0.01). Concentrations of parathyroid hormone were significantly higher in Group 4 than the other groups (p<0.01). Pre-hemodialysis norepinephrine concentrations were significantly higher in Group 4 than the other groups (p<0.05). Traditional factors associated with hypertension did not seem to be relevant to the degree of hypertension in hemodialysis patients in the present study. In conclusion, poor Kt/V urea, elevated parathyroid hormone concentrations, and elevated concentrations of plasma norepinephrine seemed to be the factors that might be associated with control of hypertension in hemodialysis patients.

Large volume abdominal paracentesis effect on some humoral factors and cardiac performance in patients with liver cirrhosis and tense ascitses

Tense ascites is one of the most disabling and distressing manifestation of liver cirrhosis. In the presence of ascites alteration in ventricular function is marked. Renin-angiotensin-aldosterone and sympathetic nervous system, whose activation is marked when tense ascites develops, could be involved as pathogenic factors causing increased left ventricular wall thickness. Large volume para-centesis [LVP] is an old but safe and effective procedure to mobilize ascitic fluid in cirrhotic patients The study evaluated the left ventricular function in patients with liver cirrhosis and tense ascites and determine the effect of total abdominal paracentesis on cardiac performance and correlated between cardiac performance and some humoral factors [renin, aldosterone, nor-epinephrine and epineph-rine] in cirrhotic patients with ascites. Fifty cirrhotic patients with tense ascites, besides 20 normal persons matched with patients in age and gender as a control group were included in our study. All patients were hospitalized and, submitted to a 4 days bed rest, low sodium diet and subjected to full investigations clinically and laboratory. Abdominal paracentesis was done to all patients [mean volume 7.5+11.7 L] with dexran-70 infusion. Blood samples were taken before and immediately after paracentesis for neurohormonal assay [plasma rennin activity PRA, plasma aldosterone PA, plasma nor-epinephrine and epinephrine]. The plasma renin activity, plasma aldosterone, plasma epinephrine, and plasma nor epinephrine was significantly higher than control. They showed significant reduction after paracentesis but still significantly higher than control levels. The results showed that sudden abdominal decompression could play a role in the post paracentesis systemic haemodynamic changes through mechanical decompression of the splanchinic vascular bed. Total paracentesis with albumin infusion causes immediate favorable effects; increasing cardiac output, suppressing plasma renin activity and plasma aldosterone, decreasing serum creatinine and blood urea nitrogen and reducing portal pressure and Porto collateral blood flow

Effects of cerastes cerastes cerastes and cerastes vipera venoms on some hormonal levels in the white rat

Viprine venoms have drastic effects on the metabolic performance of their victims. The venoms of these two vipers, Certastes cerastes cerastes [C.c.cerastes] and Cerastes vipera [C. vipera] were studied in a comparative manner focusing on some hormones related to glucose level in the blood. Both studies, in vivo and in vitro, were conducted to pinpoint the site and mechanism of action. Levels of insulin, epinephrine, norepinephrine and corticosterone significantly changed by venom injection and by perifusing isolated pancreatic islets with crude venoms. This study primarily concluded that venom of C.c.cerastes has a peptide of hypoglycemic effect. Besides, this peptide may have enough amino acid sequence to bind to anti-insulin antibodies. Venom was milked from C.c.cerastes and C.vipera reared in the serpentarium of the department. White adult male albino rats were purchased and kept in the animal house for acclimatization before experimentation. Radioimmunoassay [RIA] and spectroflourometry were used for hormonal estimation. In vitro study included isolating the pancreatic islets of Langerhans, testing their viability and testing direct effect of the venom on insulin release. While C.c.cerastes venom is hyperinsulinemic and hypoglycemic C. vipera is just the opposite. The two venoms do not adopt opposite mechanisms to effect their roles. Cc. cerastes venom includes apeptide of hypoglycemic effect, it also binds to anti-insulin antibody. Crude venoms of C.c.cerastes and C. vipera are crowds of different peptides. These peptides manifest various effects by working directly on the relevant site or by being a step in a cascade of events. These venoms showed major effects on the blood levels of insulin, epinephrine, norepinephrine and corticosterone. Furthermore, the insulinic effect shown is largely due to a peptide that mimics insulin in its activity. We concluded the presence of a hypoglycemic peptide in the venom of C.c.cerastes that demands further study and characterization

Assessment of serum catecholamine concentrations in patients with pheochromocytoma undergoing videolaparoscopic adrenalectomy

INTRODUCTION: We analyzed the changes in serum catecholamine concentrations, i.e. adrenaline and noradrenaline, in response to surgical stress in patients with pheochromocytoma who undergone videolaparoscopic adrenalectomy. MATERIALS AND METHODS: Between January 1998 and March 2002, 11 patients underwent 12 videolaparoscopic adrenalectomies. In one case, the adrenalectomy was bilateral. Serum catecholamines were measured at 6 surgical times: T0: control before induction; T1: following the induction, laryngoscopy and intubation sequence; T2: after installing the pneumoperitoneum; T3: during manipulation-exeresis of the pheochromocytoma; T4: following ablation of the pheochromocytoma; T5: in the recovery room following intervention when the patient was extubated and was hemodynamically stable. RESULTS: Mean concentrations of serum noradrenaline were significantly different when the T0 and T2 surgical times were compared (T0: 3161 pg/mL; T2: 40440 pg/mL; p < 0.01), T0 and T3 (T0: 3161 pg/mL; T3: 46021 pg/mL; p < 0.001), T1 and T3 (T1: 5531 pg/mL; T3: 46021 pg/mL; p < 0.01), T2 and T4 (T2: 40440 pg/mL; T4: 10773 pg/mL; p < 0.01) and T3 and T5 (T3: 46021 pg/mL; T5: 2549 pg/mL; p < 0.001). Mean concentrations of serum adrenaline were significantly different when the T0 and T3 surgical times were compared (T0: 738 pg/mL; T3: 27561 pg/mL; p < 0.01). CONCLUSION: The pneumoperitoneum significantly increases serum noradrenaline concentrations, manipulation of the adrenal gland significantly increases the serum concentrations of noradrenaline and adrenaline, and the pheochromocytoma ablation significantly decreases serum noradrenaline concentrations.

Effects of Delivery Nursing Care using Essential Oils on Delivery Stress Response, Anxiety during Labor, and Postpartum Status Anxiety / 간호학회지

OBJECTIVES: This study was designed to investigate the effect of delivery nursing care using essential oils on labor stress response, labor anxiety and postpartum status anxiety for primipara. METHODS: This study used nonequivalent control group pretest-posttest design. The subjects of this experiment consisted of forty eight primipara with single gestation, full term, & uncomplicated pregnancies. Twenty four primipra were in the experimental and control group each. Their mean age was 27.9 years old, their mean gestation period 279.9 days. As a treatment, delivery nursing care using essential oils was applied by nurses. Data collected epinephrine, norepinephrine, anxiety during labor. In the 24 hours after birth, the data for the postpartum mother's status anxiety was collected. Data was analyzed by t-test, repeated measures ANOVA, Mann-Whitney U test, & Wilcoxon signed ranks test with SPSS Program. RESULTS: Plasma epinephrine, norepinephrine were significantly low in the experimental group (P=0.001, P=0.033, respectively). There was no significant difference between the two groups in anxiety during labor and postpartum mother's status anxiety. CONCLUSION: These findings indicate that delivery nursing care using essential oils could be effective in decreasing plasma epinephrine, norepinephrine. But, that could not be verified in decreasing mother's anxiety.

Pressure and time dependence of the cardiopulmonary reflex response in patients with hypertensive cardiomyopathy

The first minutes of the time course of cardiopulmonary reflex control evoked by lower body negative pressure (LBNP) in patients with hypertensive cardiomyopathy have not been investigated in detail. We studied 15 hypertensive patients with left ventricular dysfunction (LVD) and 15 matched normal controls to observe the time course response of the forearm vascular resistance (FVR) during 3 min of LBNP at -10, -15, and -40 mmHg in unloading the cardiopulmonary receptors. Analysis of the average of 3-min intervals of FVR showed a blunted response of the LVD patients at -10 mmHg (P = 0.03), but a similar response in both groups at -15 and -40 mmHg. However, using a minute-to-minute analysis of the FVR at -15 and -40 mmHg, we observed a similar response in both groups at the 1st min, but a marked decrease of FVR in the LVD group at the 3rd min of LBNP at -15 mmHg (P = 0.017), and -40 mmHg (P = 0.004). Plasma norepinephrine levels were analyzed as another neurohumoral measurement of cardiopulmonary receptor response to LBNP, and showed a blunted response in the LVD group at -10 (P = 0.013), -15 (P = 0.032) and -40 mmHg (P = 0.004). We concluded that the cardiopulmonary reflex response in patients with hypertensive cardiomyopathy is blunted at lower levels of LBNP. However, at higher levels, the cardiopulmonary reflex has a normal initial response that decreases progressively with time. As a consequence of the time-dependent response, the cardiopulmonary reflex response should be measured over small intervals of time in clinical studies.

Subjective versus objective stress in noncritically ill hospitalized and outpatient adult men

Um estudo transversal de 120 indivíduos foi executado visando avaliar hormônios do estresse e estresse subjetivo (ansiedade) em casos ambulatoriais e hospitalizados. O objetivo era determinar o grau de estresse objetivo, bem como correlacionar este achado com queixas subjetivas, estimadas pelo Inventário de Ansiedade de Beck. MÉTODO: Três populações foram investigadas, nominalmente doentes clínicos ambulatoriais (Grupo I, n= 30), enfermos clínicos hospitalizados (Grupo II, n=30), e pacientes cirúrgicos hospitalizados (Grupo III, n= 30). Os controles (Grupo IV, n= 30) eram voluntários sadios recrutados entre profissionais da saúde e estudantes. Todos casos hospitalizados foram documentados na admissão, antes de quaisquer procedimentos terapêuticos, e somente homens foram selecionados em todos os grupos, a fim de contornar interações hormonais. A adrenalina, noradrenalina e cortisol foram mensurados pela manhã, e o Inventário de Ansiedade de Beck foi aplicado por uma psicóloga especializada. RESULTADOS: Os três grupos de doentes exibiram níveis de ansiedade superiores aos dos controles. As taxas hormonais não estavam apreciavelmente alteradas, e não se corelacionaram com os achados de estresse subjetivo (ansiedade). CONCLUSÕES: 1) Anormalidades subjetivas (Inventário de Ansiedade de Beck ) foram comuns tanto em populações internadas quanto ambulatoriais, sem diferenças entre os grupos; 2) Estresse objetivo (hormonal) foi mais difícil de confirmar e os valores raramente ultrapassaram a faixa de referência; 3) Não se conseguiu demonstrar correlação entre as duas órdens de variáveis; 4) Estudos adicionais são necessários para definir a quantificação e a interpretação de estresse em populações enfermas, especialmente para fins de diagnóstico nutricional e prescrição dietética;

Metabolic and stress responses of the body to trauma: produced by the laparoscopic and open cholecystectomy.

Laparoscopic cholecystectomy is regarded as gold standard therapy for symptomatic gall stone disease. This study was done to compare the metabolic and stress responses between open and lapraroscopic cholecystectomy and to evaluate their significance in postoperative recovery. Thirty patients with symptomatic gall stone disease were treated with open and laparoscopic cholecystectomy on elective basis (14 versus 16). Three samples of blood were collected from each patient to investigate serum cortisol, adrenaline, nor-adrenaline, C-reactive protein and blood glucose level. The mean age of patients was 41.86+/-10.13 blood glucose and stress hormones (cortisol, adrenaline, nor adrenaline) and C-reactive protein all were found significantly raised in the postoperative period in open cholecystectomy than laparoscopic cholecystectomy group. The postoperative recovery was also prolonged in the open group. The obvious clinical advantages of laparoscopic cholecystectomy over open cholecystectomy is mainly because of less metabolic and stress response.

Catecholamine response to exercise in individuals with different levels of paraplegia

The purpose of this study was to investigate the effect of the level of injury on the serum level of norepinephrine (Nor) and epinephrine (Epi) at rest and after maximal exercise in individuals with paraplegia. Twenty-six male spinal cord-injured subjects with complete paraplegia for at least 9 months were divided into two groups of 13 subjects each according to the level of injury, i.e., T1-T6 and T7-T12. Serum Nor and Epi concentrations were measured by HPLC-ECD, at rest (PRE) and immediately after a maximal ergospirometric test (POST). Statistical analysis was performed using parametric and non-parametric tests. Maximal heart rate, peak oxygen uptake, and PRE and POST Nor were lower in the T1-T6 than in the T7-T12 group (166 Ý 28 vs 188 Ý 10 bpm; 18.0 Ý 6.0 vs 25.8 Ý 4.1 ml kg-1 min-1; 0.54 Ý 0.26 vs 0.99 Ý 0.47 nM; 1.48 Ý 1.65 vs 3.07 Ý 1.44 nM). Both groups presented a significant increase in Nor level after exercise, while only the T7-T12 group showed a significant increase in Epi after exercise (T1-T6: 0.98 Ý 0.72 vs 1.11 Ý 1.19 nM; T7-T12: 1.24 Ý 1.02 vs 1.89 Ý 1.57 nM). These data show that individuals with paraplegia above T6 have an attentuated catecholamine release at rest and response to exercise as compared to subjects with injuries below T6, which might prevent a better exercise performance in the former group

Efeito do carvedilol na insuficiência cardíaca por cardiomiopatia dilatada: resultado de estudo duplo-cego, randômico, com grupo placebo-controle (estudo CARIBE) / Effects of carvedilol in heart failure due to dilated cardiomyopathy: results of a double-blind randomized placebo-controlled study (CARIBE study)

OBJECTIVE: To assess the effects of carvedilol in patients with idiopathic dilated cardiomyopathy. METHODS: In a double-blind randomized placebo-controlled study, 30 patients (7 women) with functional class II and III heart failure were assessed. Their ages ranged from 28 to 66 years (mean of 43ñ9 years), and their left ventricular ejection fraction varied from 8 per cnet to 35 per cent. Carvedilol was added to the usual therapy of 20 patients; placebo was added to the usual therapy of 10 patients. The initial dose of carvedilol was 12.5 mg, which was increased weekly until it reached 75 mg/day, according to the patient's tolerance. Clinical assessment, electrocardiogram, echocardiogram, and radionuclide ventriculography were performed in the pretreatment phase, being repeated after 2 and 6 months of medication use. RESULTS: A reduction in heart rate (p=0.016) as well as an increase in left ventricular shortening fraction (p=0.02) and in left ventricular ejection fraction (p=0.017) occurred in the group using carvedilol as compared with that using placebo. CONCLUSION: Carvedilol added to the usual therapy for heart failure resulted in better heart function.