Abordagem clínica da congestão pulmonar aguda no cardiopata / Clinical approach to acute pulmonary congestion in heart disease

A congestão pulmonar aguda no paciente com doença cardíaca é uma manifestação clínica de extrema gravidade, ocorrendo em aproximadamente 25% dos casosde insuficiência cardíaca aguda. O diagnóstico é essencialmente clínico, baseado na anamnese e exame físico. Os exames complementares não devem retardar o início do tratamento na sala de emergência. Descontrole pressórico, progressão da doença valvar, infarto do miocárdio e arritmias são fatores desencadeantes frequentes paraedema agudo de pulmão. O tratamento inicial fundamenta-se na suplementação de oxigênio e suporte ventilatório, administração de opioides, diuréticos e vasodilatadores endovenosos. Inotrópicos estão indicados na presença de instabilidade hemodinâmicacom disfunção orgânica...

Acute pulmonary congestion in patients with cardiac disease is a clinical manifestation of extreme severity, occurring in approximately 25% of cases of acute heart failure. Diagnosis is essentially clinical, based on history and physical examination. Complementarytests should not delay the start of treatment in the emergency room. Uncontrolled blood pressure, progression of valvular disease, myocardial infarction, and arrhythmias are common triggers for acute pulmonary edema. Initial treatment is based on supplemental oxygen and ventilatory support, administration of opioids, intravenous diuretics, andvasodilators. Inotropic agents are indicated in the presence of hemodynamic instability with organ dysfunction...

Terapia dialítica no paciente cardiopata / Dialysis therapy in patients with heart disease

A otimização das medidas para controle volêmico tem papel preponderante naabordagem de pacientes com disfunção cardíaca e renal combinada, uma vez quealterações crônicas ou agudas em um desses órgãos, em geral, induzem ou perpetuam anormalidades (funcionais e/ou estruturais) no outro. Esta revisão de literatura propõe uma análise sobre as principais medidas terapêuticas no cardiopata com disfunção renal...

Optimizing the methods used in the control of volemia is very important in the treatment of patients with combined heart and renal dysfunction, as chronic or acute changes in either of these organs generally induces or perpetuates abnormalities (functional and/orstructural) in the other. This literature review analyzes the main therapeutic methods used in heart disease with renal dysfunction...

A new methodology for polyvalent intravenous immunoglobulin solution production with a two-stage process of viral inactivation

Highly purified intravenous immunoglobulin G concentrate (IV IgG) was produced with the use of polyethylene glycol associated to a single-stage precipitation by ethanol, instead of the classic Cohn-Oncley process, which employs cold alcohol as the precipitating agent, in a three-stage process. Precipitation of crude fraction containing more than 95% of immunoglobulin G was performed by liquid chromatography with a cation exchanger, CM-Sepharose, as a stationary phase. During the process, the product was subjected to two-stage viral inactivation. The first stage was performed by the action of sodium caprylate, 30 mM at pH 5.1+/- 0.1, and the second stage was performed by the action of a solvent-detergent mixture. The finished product was formulated at 5% with 10% sucralose as the stabilizing agent. The process yields 3.3g of IgG/liter of plasma. The finished product analysis showed an anti-complementary activity lower than 1CH50. Polymer and aggregate percent levels were lower than 3% in the five batches studied. The analysis of neutralizing capacity showed the presence of antibacterial and antiviral antibodies in at least three times higher concentrations than the levels found in source plasma. The finished product fulfilled all purity requirements stated in the 4th edition of the European pharmacopeia.

Obteve-se concentrado de imunoglobulina G intravenosa IgGIV, altamente purificado, utilizando-se polietilenoglicol associado a uma única etapa de precipitação por etanol, em substituição ao tradicional método descrito por Cohn-Oncley, que emprega, em três etapas, o mesmo álcool resfriado, como agente precipitante. A purificação da fração bruta contendo mais de 95% de imunoglobulina G foi realizada utilizando-se cromatografia líquida com um trocador de cátion, a CM-Sepharose, como fase estacionária. Durante o processamento o produto foi submetido a dupla inativação viral sendo a primeira pela ação do caprilato de sódio, 30 mM a pH 5,1+/- 0,1 e a segunda por ação de mistura de solvente/detergente. O produto acabado foi formulado a 5% utilizando-se sucralose 10% como estabilizante. O rendimento da metodologia foi de 3,3g de IgG/litro de plasma. A análise do produto acabado demonstrou atividade anti-complementar inferior a 1CH50. O valor percentual de polímeros e agregados em cinco lotes realizados foi inferior a 3%. O estudo da capacidade de neutralização demonstrou a presença de anticorpos anti-bacterianos e anti-virais em concentração pelo menos três vezes maior que o plasma de origem. O produto acabado apresentou conformidade com todos os requisitos de pureza dispostos na farmacopéia européia IV edição.

Nanofiltration process on dye removal from simulated textile wastewater

Dyestuffs removal from industrial wastewater requires special advanced technologies, since dyes are usually difficult to remove by biological methods. In this study nanofiltration process was used for removal of different dyestuffs from solutions. The rate of dye removal by spiral wound nanofiltration membrane in film thin composite MWCO=90 Dalton, was evaluated for four classes of dyes acidic, disperse, reactive and direct in red and blue dyes medium. Dye absorbance was measured by spectrophotometric method [2120 Standard Method 1998]. Effects of feed concentration, pressure and total dissolved solids concentration were also studied. Results showed that increasing dye concentration lead to higher color removal up to 98% and at different pressures for acidic and reactive blue were up to 99.7%. Different types of dyes had no effect on dye removal and permeate flux. During 2 h. of the operation time, permeate flux decline was increased. Permeate fluxes for different types of red dyes were from 16.6 to 12.6 [L/m[2]/h.] and for blue dyes were from 16.6 to 10.45 [L/m[2]/h.]. Presence of sodium chloride in dye solutions increased dye rejections nearby 100%. Chemical oxygen demand removal efficiencies for reactive blue, disperse blue, direct and disperse red dyes were also approximately 100%

Ultrafiltración como alternativa terapéutica en la insuficiencia cardíaca congestiva / Ultrafiltracion like therapeutic alternative in the congestiva insufficiency cardiac

La insuficiencia cardiaca congestiva es un síndrome complejo que representa un problema de salud pública. En los casos con excesiva retención de líquidos, los intentos por mantener un estado euvolémico sostenido son en ocasiones insuficientes y su manejo tradicional con diuréticos, tanto de manera aguda como crónica, no ha demostrado incrementar la supervivencia de estos pacientes a largo plazo y de manera paradójica, agrava el círculo vicioso neurohormonal, que es el sustrato fisiopatológico principal de esta entidad. En este contexto, la ultrafiltración surge como alternativa terapéutica capaz de remover cantidades significativas de fluido en este tipo de pacientes, mejorando su capacidad funcional y perfil de peso de manera sostenida, al atenuar la estimulación del eje renina-angiotensina-aldosterona y sistema nervioso simpático. Su tolerancia y perfil de seguridad son adecuados. Futuros estudios analizarán la relación costo/beneficio de esta terapia y su aplicación a mayor escala.

Circulatory response to fluid overioad removal and sustained hemodynamic efficacy of slow ultrafiltration in refractory congestive heart failure

To determine to what extent patients with chronic refractory congestive heart failure [rCHF] benefit from slow Ultrafiltration. Prospective, observational study of chronic refractory congestive H.F. Effectiveness data from several sources, including observational studies, published systemic reviews, The New York Heart Association [NYHA] classification of Heart failure and expert opinion. New York Heart Association [NYHA] class III and IV, resting left ventricular ejection fraction < 35%, Dilated cardiomyopathy, Ischemic cardiomyopathy and normal or mild elevated serum creatinine < 3 mg/dl. Forty Patients, eighteen men [45%] and twenty two women [55%], their ages ranged from 32 to 63 years [mean 47 +/- 9 years] with refractory CHF, with NYHA functional class IV [n = 32] represent 80% and class III [n = 8] represent 20% of patients, were selected from intensive care units of Internal Medicine and Cardiology Departments of Tanta university Hospital. Exclusion criteria were patients with advanced valvular heart diseases and patients with chronic renal failure - All patients were subjected to the following assessments : Daily morning B.W, HTC%, Serum electrolytes [Na[+], K[+], Ca[+2]], Blood urea and S. creatinine, Urine output [ml/24h.] and homodynamic monitoring including H.R, Systemic BL Pr and CVP [by double luminal catheter], Chest x-ray P.A view, examination for interstitial and/or clear cut alveolar pulmonary edema before and after ECUF [Extra corporeal ultrafiltration] ECG and Trans-thoracic Echocardiography [M-mode, two dimensional and Doppler Echocardiography]. Controlled ultrafiltration between 0.5-1 L/h., was initiated at a rate of 0.5 L/h to be readjusted subsequently according to the hemodynamic parameters available. All patients were subjected to ECUF treatment ranged from 3 sessions in 12 patients and 4 sessions in 28 patients [mean 3.7 session/ptn], and about 4-6 h/session. Average amount of ultrafiltrate /session ranged from 2-3.5 liters [mean 2.6 +/- 0.4 liter] over duration of 15 days hospital admission. Both number and repetition frequency were decided empirically on the basis of evolution of symptoms and response to drugs. ECUF was discontinued when it was considered clinically that the maximum benefit has been obtained. Highly significant diuresis from [0.34 +/- 0.14 to 2.0 +/- 0.7 L/day] [P < 0.001], reduction in the mean H.R[120 +/- 5.0 to 98 +/- 11.0 beat/min] [P < 0.001], CVP reduction [28.5 +/- 2.0 to 15.5 +/- 7.0 cm water] [P < 0.001], Intra-venous volume as assessed by HCT value [33.8 +/- 2.3% to 37.6 +/- 2.0%], [P < 0.001] before and after ECUF. ECHO was repeated after ECUF revealed highly significant reduction in the mean LVEDD from 7.0 +/- 0.2 cm before to 6.4 +/- 0.6 cm after ECUF [P < 0.001], LVESDfrom 6.5 +/- 0.4 cm before to 5.5 +/- 0.8 cm after ECUF [P< 0.001]. LVEF was 23.8 +/- 4.1% before and increased to 31.2 +/- 8.2% after ECUF [P < 0.001], highly significant reduction in the mean L A dimensions from 5.3 +/- 0.3 cm before to 4.8 +/- 0.6 cm after ECUF [P < 0.001], RV dimensions from 4.7 +/- 0.4 cm before to 4.0 +/- 0.8 cm after ECUF [P < 0.001]. Significant changes in S.urea from 105.7 +/- 55.2 mmol /L to 91.3 +/- 63.04 mmol /L] [P < 0.047], S. creatinine from [1.9 +/- 0.6 to 1.5 +/- 0.9 mmol/L] [P < 0.017] before and after ECUF. ECUF offers a reasonably effective and relatively safe method in the management of r CHF. The relative ease of the procedure and low incidence of complications denote that this technique is an extremely useful one in selected cases of H.F, refractory to the conventional therapy with oliguria and fluid overload

Bioconversão de sacarose em ácido glicônico e frutose usando reator com membrana / Sucrose bioconversion into gluconic acid and fructose using a membrane reactor

A conversão enzimática da sacarose pela ação sucessiva da invertase e da glicose oxidase (GOD), permite obter produtos de maior valor agregado, a saber, frutose e o ácido glicônico, dois produtos de amplo uso na indústria farmacêutica, alimentícia e química. Foi estudada a aplicação da invertase imobilizada em resinas aniônicas do tipo Dowex® (um copolímero de poliestireno-divinilbenzeno) sobre a hidrólise da sacarose bem como a oxidação da glicose pela glicose oxidase solúvel ou imobilizada no mesmo suporte em separado (sistema bifásico), utilizando-se um reator de membrana acoplado à membrana de ultrafiltração (100kDa) ou de microfitração (5µm). Posteriormente, avaliou-se o desempenho de ambas as formas de enzimas, solúveis ou imobilizadas num sistema monofásico empregando o mesmo reator...

The enzymatic conversion of sucrose through a successive action of invertase and glucose oxidase (GOO) allows the obtainment of products with higher commercial value, fructose and gluconic acid, which are widely used in pharmaceutical, food and chemical industries. Invertase and GOO immobilized on Dowex® anionic resin (a polystyrene divinylbenzene copolymer) as well as soluble GOD were used in a membrane bioreactor (MS) for sucrose hydrolysis and glucose oxidation. The MB was coupled with a UF-membrane (100kDa) or a MF-membrane (5µm). The bioconversion was conducted in two steps (biphasic system) as well as in one step (monophasic system). The bioconversion operated in a biphasic system permitted obtaining a fructose syrup with a concentration of about 70% through a separation of glucose and fructose using a cationic resin, 50W:8-100. As for the monophasic system, the yield of 96.6% and 67.4% for soluble and immobilized forms were attained respectively. No leakage of the enzymes from the support allowed the use of a microfiltration membrane, adding advantages to the membrane bioreactor operation.

Evaluation of extracorporeal ultrafiltration in the management of refractory congestive heart failure

Refractory congestive heart failure [CHF] usually represents the end stage of cardiac disease in which hypotension and oliguria lead to progressive generalized edema. The aim of the present work was to assess the symptomatic response, hemodynamic benefits and side effects of extra-corporeal ultrafiltration [ECUF] therapy in patients with refractory CHF who failed to respond to conventional anti-failure measures. Sixteen patients with refractory CHF who belonged to class IV of the New York Heart Association [NYHA] classification were included in this study. They were 7 men and 9 women with ages ranging from 32 to 63 yr [mean 47 +/- 9 yr]. The causes of heart failure were: ischemic heart disease in 3 patients, rheumatic heart disease in 5 and dilated cardiomyopathy in 8. All patients had ECUF therapy, 1-6 sessions/patient, each lasting 4-6 hr with an average amount of ultrafiltrate 2.6 +/- 0.4 L/session. All patients had serial: echocardiography, hemodynamic monitoring, chest X-ray, serum electrolyte and hematocrit estimation in addition to routine laboratory tests both pre- and post ECUF. Response to ECUF was considered according to improvement of patients' clinical status, and cardiac and renal functions. Eleven patients were responders [68.5%], 3 were partial responders [18.5%] while 2 were non-responders [13%]. In responder group, edema disappeared, 5 patients [31%] became NYHA class III, with significant diuresis and decrease of body weight. In addition, there was a significant reduction in heart rate, central venous pressure and radiographic cardiothoracic ratio. After ECUF there was a significant increase of serum sodium concentration whereas no-significant changes were observed in serum calcium, potassium, urea or creatinine. By echo cardiography there was a significant reduction in all cardiac chamber dimensions with significant improvement of left ventricular contractility. ECUF offers a reasonably effective and relatively safe method in the therapeutic options of refractory CHF

Adecuación de la diálisis peritoneal continua ambulatoria en pediatría / Adecuacy of continuous ambulatory peritoneal dialysis in children

When the use of dialytical therapy is decided after a careful assessment of clinical and laboratory variables, the close supervision of the procedure, that allows a feedback between our indications and its clinical efficacy, is essential. The correct and routine use of validated adequacy tools such as Kt/V and the Peritoneal Equilibration Test (PET) is mandatory. We compare the adequacy figures for adult and pediatric populations, mentioning the Kt/V and PET values obtained in eight patients followed during 12 months in a Nephrology Unit. An initial Kt/V of 2.04 and of 2.14 after 12 months of procedure are values that adjust to the general recommendations discussed in this paper. According to PET results, this group of patients were classified as low average for ultrafiltration and high average for creatinine clearance. Based on the local experience and literature review, some recommendations are made for the management of peritoneal dialysis in children

Análisis del sellamiento apical utilizando la técnica de obturación ultrafil / Analysis of the quality of dental apical duct sealment by the ultrafil obturation technique

El propósito de este estudio fue comparar el sellamiento apical con una técnica de inyección de gutapercha termoplastitificada, contra el de otras dos técnicas convencionales, mediante un método de filtración especialmente diseñado para este tipo de investigaciones. La muestra fue de 138 conductos, clasificados a su vez en tres grupos lo más homogéneamente posible. Dcihas muestras fueron sometidas a la técnica de filtración con azul de metileno al 2 por ciento en condiciones de vacío. Los mejores resultados de sellamiento apical con un menor promedio de filtración, fueron para la técnica lateral modificada (1.03 mm), seguidad por la técnica ultrafil (1.11 mm) y por último la técnica de condensación térmica utilizando compactadores de Mc Spadden(1.28 mm)

Ascitic fluid filtration and intravenous infusion versus total-volume paracentesis with infusion of plasma expander in cirrhosis with tense or intractable ascites.

BACKGROUND: Patients with cirrhotic ascites have low serum albumin levels, and paracentesis of ascitic fluid could compromise them further. AIM: We compared the therapeutic efficacy of ascitic fluid filtration and concentrate infusion (AFI) versus total-volume paracentesis (TVP) with colloid infusion in control of tense or intractable cirrhotic ascites. METHODS: Ten patients underwent AFI; their ascitic fluid was filtered repeatedly through hollow-fiber hemodialyzer, and the concentrate reinfused intravenously. In ten patients TVP was done with simultaneous intravenous colloid infusion. Follow-up was done weekly and the study terminated if the patient needed diuretics or developed complications. RESULTS: Pre-study parameters were similar in the two groups. In the AFI and TVP groups, the duration of procedure was median 12 hours and 5.5 hours; fluid removed by paracentesis was 10.2 L and 8.0 L, respectively; and fluid infused intravenously was 0.5 L [with mean (SD) protein content 5.7 (1.3) g/dl] and 1.1 L, respectively. Glomerular filtration rates were lower than normal in the two groups but did not change significantly with the procedure; body weight remained significantly lower up to week 3 and week 2, respectively. The study was terminated at median week 3 (range 1-8) and week 2 (1-4), respectively. Fever was an accompaniment of AFI and one patient developed peritonitis. CONCLUSION: Patients undergoing AFI remained diuretic-free longer; the procedure is cost-effective but needs to be further evaluated to minimize the side-effects.

Procedimientos dialíticos no convencionales: hemofiltración / Non-conventional hemodialytic procedure: hemofiltration

El artículo plantea las bases científicas y operativas de la técnica de Hemofiltración. Propone los aspectos destacados de la participación de enfermería en el monitoreo del procedimiento y la asistencia de enfermería al paciente

Traitement des insuffisances cardiaques refractaires par ultrafiltration extracorporelle

In order to precise the further and immediate effects of extracorporeal ultrafiltration [U.F.] during the refractory cardiac failures, a retrospective study has been performed. Ten patients, with phase III cardiac failure, presenting, 3 episodes of subclavian cathter U.F. These episodes have been well tolerated. The immediate results have been spectacular in 6 patients with a notable loss of weight, disapperance of aedemas, of functionnal gene and a resuming of diuresis. As to further resuls, 6 months later: 5 patients died, 2 were lost of sight and remaining three are keeping a stable cardiac state under a digitalo-diuretic and vasodilating treatment. In conclusion, during the refractory cardiac failure, the U.F. can give forth good results in the immediate, in wait for an eventual more appropriate treatment

Mistura em pó de soro de queijo ultrafiltrado e extrato proteíco líquido de soja em produtos de panificaçäo / A powder mixture of ultrafiltrated cheese whey and soybean protein liquid extract in bakery products

O trabalho mostra os efeitos da substituiçäo parcial do leite em formulaçöes de produtos de panificaçäo dos tipos päo, bolo e biscoito por mistura de soro de queijo ultrafiltrado mais "leite" de soja. Após ultrafiltraçäo do soro de queijo, foi feita a mistura com "leite" de soja e, a seguir, desidratada em "spray-drier". Os resultados obtidos mostraram a viabilidade técnica da substituiçäo, inclusive com melhorias de sabor dos produtos processados

Improving the quality of fresh white soft cheese made from ultrafiltrated milk

Fresh buffalos skim milk was ultrafiltrated to a concentration factor of 4: 1. Fresh cream was added to the retentate to give a fat content of 10%. The salt was added by a ratio of 4%. Skim milk powder was used to rise the total solids of the pre-cheese milk to 35%. Full aged pre-ripened goat-slurry was added at a level of 1, 3 and 5%, respectively. Slurry-pre-cheese-milk was renneted directly in plastic containers and sealed with aluminum foil. Chemical, microbiological and organoleptic evaluation of cheese showed that addition of slurry improved flavor of the young cheese and produced more smooth and favorite body and texture, which were absent in the control cheese. The slurry was more efficient when it was added by a rise order