[Translated article] Safe administration of noradrenaline by the peripheral route: A systematic review.

PURPOSE: To review and analyse the available literature on peripheral administration of noradrenaline (NA) with the aim of providing recommendations to ensure correct use and patient safety. METHODS: Systematic review on the databases PubMed, ISI Web of Science, SCOPUS, and Science Direct, using the following search terms: ("Noradrenaline" [Mesh]) AND ("Norepinephrine" [Mesh]) AND ("Vasopressors" [Mesh]) AND ("Peripheral infusions" [Mesh]) OR ("Extravasations" [Mesh]). A total of 1040 articles were identified. Animal studies and studies written in languages other than English were excluded. Finally, 83 articles were included. RESULTS: NA can be administered peripherally. The risk of extravasation should be taken into account, with phentolamine being the first pharmacological line of treatment. It has also been related to the appearance of thrombophlebitis, cellulitis, tissue necrosis, limb ischaemia, and gangrene, although its incidence seems to be low. The use of peripheral NA in children seems to be carried out without obvious complications. The use of standard concentrations is suggested to reduce the risk of errors. It is recommended to use 0.9% saline as the default diluent for peripheral NA. CONCLUSIONS: Peripheral infusions of NA could be a safe and beneficial option in early resuscitation provided that a number of guidelines are followed that reduce the likelihood of complications associated with this route.

Safe administration of noradrenaline by the peripheral route: A systematic review. / Administración segura de noradrenalina por vía periférica: una revisión sistemática.

PURPOSE: To review and analyze the available literature on peripheral administration of noradrenaline (NA) with the aim of providing recommendations to ensure correct use and patient safety. METHODS: Systematic review on the databases PubMed, ISI Web of Science, SCOPUS and Science Direct, using the following search terms: ("Noradrenaline" [Mesh]) AND ("Norepinephrine" [Mesh]) AND ("Vasopressors" [Mesh]) AND ("Peripheral infusions" [Mesh]) OR ("Extravasations" [Mesh]). A total of 1,040 articles were identified. Animal studies and studies written in languages other than English were excluded. Finally, 83 articles were included. RESULTS: NA can be administered peripherally. The risk of extravasation should be taken into account, with phentolamine being the first pharmacological line of treatment. It has also been related to the appearance of thrombophlebitis, cellulitis, tissue necrosis, limb ischemia and gangrene, although its incidence seems to be low. The use of peripheral NA in children seems to be carried out without obvious complications. The use of standard concentrations is suggested to reduce the risk of errors. It is recommended to use 0.9% saline as the default diluent for peripheral NA. CONCLUSIONS: Peripheral infusions of NA could be a safe and beneficial option in early resuscitation provided that a number of guidelines are followed that reduce the likelihood of complications associated with this route.

Factors associated with vasoplegic shock in the postoperative period of cardiac surgery and influence on morbidity and mortality of the use of arginine vasopressin as rescue therapy.

OBJECTIVES: Analyzing associated factors with vasoplegic shock in the postoperative period of Cardiac Surgery. Analyzing the influence of vasopressin as rescue therapy to first-line treatment with norepinephrine. DESIGN: Cohort, prospective and observational study. SETTING: Main hospital Postoperative Cardiac ICU. PATIENTS: Patients undergoing cardiac surgery with subsequent ICU admission from January 2021 to December 2022. INTERVENTIONS: Record of presurgical, perioperative and ICU discharge clinical variables. MAIN VARIABLES OF INTEREST: chronic treatment, presence of vasoplegic shock, need for vasopressin, cardiopulmonary bypass time, mortality. RESULTS: 773 patients met the inclusion criteria. The average age was 67.3, with predominance of males (65.7%). Post-CPB vasoplegia was documented in 94 patients (12.2%). In multivariate analysis, vasoplegia was associated with age, female sex, presurgical creatinine levels, cardiopulmonary bypass time, lactate level upon admission to the ICU, and need for prothrombin complex transfusion. Of the patients who developed vasoplegia, 18 (19%) required rescue vasopressin, associated with pre-surgical intake of ACEIs/ARBs, worse Euroscore score and longer cardiopulmonary bypass time. Refractory vasoplegia with vasopressin requirement was associated with increased morbidity and mortality. CONCLUSIONS: Postcardiopulmonary bypass vasoplegia is associated with increased mortality and morbidity. Shortening cardiopulmonary bypass times and minimizing products blood transfusion could reduce its development. Removing ACEIs and ARBs prior to surgery could reduce the incidence of refractory vasoplegia requiring rescue with vasopressin. The first-line treatment is norepinephrine and rescue treatment with VSP is a good choice in refractory situations. The first-line treatment of this syndrome is norepinephrine, although rescue with vasopressin is a good complement in refractory situations.

Infusión de adrenalina y noradrenalina para manejo de hipotensión materna post bloqueo espinal

Objetivos: demostrar el efecto de la infusión de adrenalina en relación con la noradrenalina con el propósito de prevenir la hipotensión materna post anestesia intradural. Métodos: estudio prospectivo, longitudinal, analítico y doble ciego con enfoque cuantitativo. Población de 114, muestra de 46 pacientes dividido en 2 agrupaciones. grupo A (noradrenalina) y grupo B (adrenalina) a dosis de 0,02 mcg/kg/min. Medición de variables continuas se sacó media y aplicación de prueba de normalidad de Shapiro- Wilk. Se aplicó T de student para las medias y U de Mann - Whitney para las medianas. En variables nominales se sacó frecuencia. Resultados: la media de la edad entre 32 a 33 años de ambas agrupaciones, con latido cardiaco significativo en T3 y T4 para el grupo B, valor p 0,045 y 0,000. Sin cambios importantes en la tensión arterial ni en las puntuaciones del APGAR. Los efectos secundarios son la presencia de cefalea posiblemente relacionado con uso de oxitocina. 18 y 16 pacientes no presentaron hipotensión con chi cuadrado de 0,89. Volumen total de cristaloides de 650 ml a 700 ml tanto en el grupo A y B. El costo referencial fue de 0,9 bolivianos. Conclusiones: la adrenalina es un vasopresor sugerente, sin alteraciones en los latidos cardíacos maternos, pero con un mayor control que la noradrenalina, y con una acción similar en la tensión arterial media en ambas agrupaciones.

Objectives: to demonstrate the effect of adrenaline infusion in relation to noradrenaline for the purpose of preventing maternal hypotension post intradural anesthesia. Methods: a total of 114 people, a sample of 46 patients, are distributed in 2 distinct group: A (noradrenaline) and B (adrenaline) at a dose of 0.02 pg/kg/ min. Mean of continuous variables was measured and Shapiro - Wilk normality test was applied. Student's T was applied for the means and Mann-Whitney U for the medians. The frequency was determined for nomina variables. Results: the age was 32 to 33 years, with a significant heartbeat in T3 and T4 for group B, p value 0.045 and 0.000. No significant changes in blood pressure or APGAR scores. Side effects are the presence of headache possibly related to the use of oxytocin. 18 and 16 patients did not present hypotension with chi square of 0.89 Total volume of crystalloids from 650 ml to 700 ml in both groups A and B. The reference cost was 0.9 bolivianos Conclusions: adrenaline is a suggestive vasopressor, without alterations in maternal heartbeat, but with greater control than noradrenaline, and with a similar action on mean arterial pressure in both groups.

Hipotensión refractaria secundaria a tratamiento crónico con altas dosis de quetiapina / Refractory hypotension secondary to chronic treatment with high doses of quetiapine

La quetiapina es un antipsicótico atípico que se usa en el tratamiento del trastorno depresivo, esquizofrénico o bipolar. Su acción reside en su acción sobre los receptores de la dopamina D1 y D2, histamina y serotonina 5HT1A y 5HT2. Sin embargo, también tiene antagonismo para los receptores α1, provocando efectos secundarios cardiovasculares, entre ellos la hipotensión. Presentamos el caso de un paciente medicado crónicamente con quetiapina que presentó hipotensión refractaria a vasoconstrictores y fluidoterapia intraoperatoria. La noradrenalina tiene un fuerte efecto α1 con una menor afinidad para los receptores β2 a diferencia de la adrenalina. Esto se traduce en una vasoconstricción periférica y la resultante mejoría del cuadro clínico. Por lo tanto, se debe considerar el fármaco vasoactivo de elección en la hipotensión refractaria en pacientes que tomen altas dosis de quetiapina.(AU)

Quetiapine is an atypical antipsychotic used in the treatment of depressive, schizophrenic, or bipolar disorders. It acts on dopamine D1 and D2, histamine, and 5HT1A and 5HT2 receptors. However, it also acts as an antagonist for α1 receptors causing cardiovascular side effects, including hypotension. We present the case of a patient chronically medicated with quetiapine who developed hypotension refractory to vasoconstrictors and intraoperative fluid therapy. Noradrenalin has a strong α1 effect with lower affinity for β2 receptors unlike adrenalin. This translates into peripheral vasoconstriction and an improved clinical picture. Therefore, it should be considered the vasoactive drug of choice in patients on high doses of quetiapine.(AU)

Refractory hypotension secondary to chronic treatment with high doses of quetiapine.

Quetiapine is an atypical antipsychotic used in the treatment of depressive, schizophrenic, or bipolar disorders. It acts on dopamine D1 and D2, histamine, and 5HT1A and 5HT2 receptors. However, it also acts as an antagonist for α1 receptors causing cardiovascular side effects, including hypotension. We present the case of a patient chronically medicated with Quetiapine who developed hypotension refractory to vasoconstrictors and intraoperative fluid therapy. Noradrenalin has a strong α1 effect with lower affinity for ß2 receptors unlike adrenalin. This translates into peripheral vasoconstriction and an improved clinical picture. Therefore, it should be considered the vasoactive drug of choice in patients on high doses of Quetiapine.

Catecholamines production by kidney tissue and mesangial cell culture is differentially modulated by diabetes / A produção de catecolaminas pelo tecido renal e a cultura de células mesangiais é modulada diferencialmente pelo diabetes

Abstract Introduction: According to the International Diabetes Federation, the number of people with diabetes mellitus may reach 700 million in 2045. Catecholamines are involved in the regulation of several kidney functions. This study investigates the effects of hyperglycemia on catecholamines' metabolism in kidney tissue from control, diabetic, and insulin-treated diabetic rats, both in vivo and in vitro. Methods: Male Wistar-Hannover rats were randomized into: control, diabetic, and insulin-treated diabetic groups. Diabetes was induced by a single injection of streptozotocin, and diabetic treated group also received insulin. After 60 days, blood and kidney tissue from all groups were collected for catecholamines' quantification and mesangial cells culture. Results: diabetic rats had lower body weight, hyperglycemia, and increase water intake and diuresis. Additionally, diabetes promoted a sharp decrease in creatinine clearance compared to control group. Regarding the whole kidney extracts, both diabetic groups (treated and non-treated) had significant reduction in norepinephrine concentration. In mesangial cell culture, catecholamines' concentration were lower in the culture medium than in the intracellular compartment for all groups. Norepinephrine, epinephrine, and dopamine medium levels were increased in the diabetic group. Conclusion: The major finding of the present study was that 8 weeks of diabetes induction altered the kidney catecholaminergic system in a very specific manner, once the production of catecholamines in the excised kidney tissue from diabetic rats was differentially modulated as compared with the production and secretion by cultured mesangial cells.

Resumo Introdução: Segundo a Federação Internacional de Diabetes, o número de pessoas com diabetes mellitus pode chegar a 700 milhões em 2045. As catecolaminas estão envolvidas na regulação de várias funções renais. Este estudo investiga os efeitos da hiperglicemia no metabolismo das catecolaminas no tecido renal de ratos controle, diabéticos e diabéticos tratados com insulina, tanto in vivo como in vitro. Métodos: Os ratos Wistar-Hannover machos foram randomizados em: grupos controle, diabéticos e diabéticos tratados com insulina. O diabetes foi induzido por uma única injeção de estreptozotocina, e o grupo diabético tratado também recebeu insulina. Após 60 dias, sangue e tecido renal dos grupos foram coletados para quantificação de catecolaminas e cultura de células mesangiais. Resultados: ratos diabéticos apresentaram peso corporal mais baixo, hiperglicemia, e aumento da ingestão de água e diurese. Ademais, o diabetes promoveu uma redução acentuada na depuração de creatinina comparado com o grupo controle. Quanto aos extratos de rim total, ambos os grupos diabéticos (tratados/não tratados) tiveram redução significativa na concentração de noradrenalina. Na cultura de células mesangiais, a concentração de catecolaminas foi menor no meio de cultura do que no compartimento intracelular para todos os grupos. Níveis médios de noradrenalina, adrenalina e dopamina estavam aumentados no grupo diabético. Conclusão: O principal achado deste estudo foi que 8 semanas de indução de diabetes alteraram o sistema catecolaminérgico renal de maneira muito específica, já que a produção de catecolaminas no tecido renal excisado de ratos diabéticos foi modulada diferencialmente comparada com produção e secreção por células mesangiais cultivadas.

Adrenergic signaling molecular complexes. / Complejos moleculares de la señalización adrenérgica.

Adrenaline and noradrenaline bind to membrane receptors of the superfamily of G protein-coupled receptors (GPCR) in target cells, where they modulate physiological responses such as metabolism, vasoconstriction, vasodilation and proliferation. Alteration in their function is associated with conditions such as hypertension, benign prostatic hyperplasia and cardiac hypertrophy. In response to adrenaline, receptors form signaling complexes, which enables adrenergic action to be specific, rapid and efficient. These signaling complexes or signalosomes are composed of kinases, phosphatases, and adapter and scaffold proteins, which together modulate the receptor function. Manipulation of each protein-protein interaction of the adrenergic signaling complex emerges as a promising therapeutic strategy for the design of drugs that modulate adrenergic action and help to define its pathophysiological significance. An important biological model to perform these investigations is the heart, since it expresses all adrenergic receptors; to date, several heart signalosomes have been described. Mass spectrometry (proteomics), genetic manipulation and biochemical assays, such as two-hybrid and co-immunoprecipitation assays, are tools that are used in these studies.

La adrenalina y la noradrenalina se unen a receptores membranales de la superfamilia de receptores acoplados a proteínas G (GPCR) en las células blanco, donde modulan respuestas fisiológicas tales como el metabolismo, vasoconstricción, vasodilatación y proliferación. La alteración en su función está asociada con hipertensión, hiperplasia prostática benigna e hipertrofia cardiaca. En respuesta a la adrenalina, los receptores forman complejos de señalización, lo que permite que la acción adrenérgica sea específica, rápida y eficiente. Estos complejos de señalización o signalosomas están integrados por cinasas, fosfatasas, proteínas adaptadoras y de andamio, que en conjunto modulan la función del receptor. La manipulación de cada interacción proteína-proteína del complejo de señalización adrenérgico emerge como una estrategia terapéutica prometedora para el diseño de fármacos que modulen la acción adrenérgica y ayuden a definir su significado fisiopatológico. Un modelo biológico importante para realizar estos estudios es el corazón, ya que expresa todos los receptores adrenérgicos; en la actualidad se han descrito varios signalosomas cardiacos. La espectrometría de masas (proteómica), manipulación genética y ensayos bioquímicos como el doble híbrido o la coinmunoprecipitación son herramientas que se emplean en estos estudios.

Psicobiología del suicidio y las ideas suicidas / Psychobiology of suicide and suicidal ideas

Se realiza una revisión de las principales basesgenéticas y neurobiológicas del suicidio y lasideas suicidas, analizando las contribuciones de la genética y la imagenología estructuraly funcional. Se comparan principalmente lasdiferencias entre pacientes depresivos con ysin ideas suicidas. Se comprueba el peso de losantecedentes familiares y genéticos como unaprimera contribución a la vulnerabilidad suicida. Los estudios estructurales muestran los cambios hipometabólicos más globales (corteza temporal, parietal, etc.) correspondientes a la depresión, con una diferencia distintiva en las áreas prefrontales, particularmente en las regiones mediales laterales y basales en los pacientes suicidas. Se comprueban las alteraciones bioquímicas centradas en el metabolito de la serotonina, elácido 5-hidroxiindolacético (5-HIAA) y en losreceptores postsinápticos y recaptadores deserotonina, también en las áreas prefrontales.Se analizan los estudios que atribuyen a estoscambios la disfunción cognitiva observada en pacientes suicidas.

A review of the main genetic and neurobiological bases of suicide and suicidal ideas is carried out, analyzing the contributions of genetics and structural and functional imaging. The differences between depressive patients with and without suicidal ideas are mainly compared. The weight of family and genetic background is checked as a first contribution to suicidal vulnerability. Structural studies show the most global hypometabolic changes (temporal cortex, parietal, etc.) corresponding to depression, with a distinctive difference in the prefrontal areas, particularly in the medial-lateral and basal regions in suicidal patients. Biochemical alterations are verified in the serotonin metabolite, 5-hydroxyindoleacetic acid (5-HIAA) and in post-synaptic receptors and deserotonin reuptakers, also in prefrontal areas. They attribute to these changes the cognitive dysfunction observed in suicidal patients.

Cambios observados en la concentración cerebral de catecolaminas, con Datura stramonium / Changes observed in brain catecholamine concentration, with Datura stramonium

Datura stramonium ha sido empleada empíricamente en la medicina tradicional mexicana desde antes de la conquista española, y después, a partir del siglo XVI, para diversos fines; entre otros datos se refiere que produce anorexia y agresividad. También se ha usado en la enfermedad de Parkinson. Con esos antecedentes se consideró de interés investigar el efecto de un extracto hidroalcohólico de esta planta sobre la concentración de dopamina (DA) cerebral en la rata. Se administró la substancia en estudio por medio de un catéter esofágico a la dosis de 0.25 ml/d a diferentes dinamizaciones. El grupo testigo mostró valores (X ± A) de 1197 ± 138 ng/g, y el que recibió la droga a la 12CH tuvo un promedio de 1607 ± 398 ng/g (p < 0.05). Las dinamizaciones más bajas (3CH y 6CH) produjeron elevaciones más moderadas, sin significación estadística...

Datura stramonium has been used empirically in ancient Mexican medicine and after the XVI century. It is known to produce anorexia and aggressiveness. It has also been used in Parkinson’s disease. For these reasons it seemed interesting to study the effect of different dynamizations of Datura stramonium on brain dopamine (DA) in the rat. The drug was administered by esophagic catheter at a dose of 0.25 ml/d. The control group showed values (X ± A) of 1197 ± 138 ng/g and the animals which received the extract at 12CH had a mean value of 1607 ± 398 ng/g (p < 0.05). The lower dynamizations (3CH and 6CH) induced more moderate increases without statistical significance...

Acción de Lachesis trigonocephalus en diferentes potencias sobre las catecolaminas cerebrales / Lachesis trigonocephalus action in different potencies on brain catecholamines

Durante el Congreso Internacional del Centenario de la Escuela Libre de Homeopatía de México, celebrado en 2012, la doctora Josefina Sánchez Reséndiz presentó esta ponencia para hablar de los beneficios que la salud femenina puede tener gracias al uso de algunos medicamentos homeopáticos, en especial Lachesis trigonocephalus. De manera breve y precisa, la doctora Sánchez Reséndiz recordó los resultados de las investigaciones que realizó con el doctor Ángel Lerdo de Tejada y colaboradores sobre las catecolaminas cerebrales, partiendo de que la dopamina cerebral, a nivel del hipotálamo, tiene una gran influencia en la hormona luteinizante y en la conducta. Se pudo observar que el medicamento homeopático Lachesis trigonocephalus, a diferentes potencias, puede generar modificaciones estadísticamente significativas en las catecolaminas cerebrales, mecanismo por el cual, su uso podría ser capaz de mejorar los síntomas de la mujer durante el climaterio y la menopausia...

During the International Congress, in the 100th aniversary of the Escuela Libre de Homeopatía in Mexico, held in 2012, Josefina Sanchez Resendiz MD presented this conference to discuss about women’s health benefits that can be obtained by the use of some homeopathic medicines, especially Lachesis trigonocephalus. In a brief and precise way, Dr. Sanchez Resendiz recalled the results of the research conducted with Angel Lerdo de Tejada MD and collaborators on brain catecholamines, since brain dopamine in the hypothalamus, has a great influence in the luteinizing hormone its behavior. She observed that different potencies of the homeopathic remedy Lachesis trigonocephalus, can generate statistically significant changes in brain catecholamines. This could explain why its use may improve women’s symptoms during perimenopause and menopause...

Efecto de Lachesis trigonocephalus sobre dopamina cerebral en la rata / Lachesis trigonocephalus effect on dopamine in the rat brain

La dopamina (DA) estimula el factor liberador de hormona luteinizante (LHR), incrementa la hormona luteinizante (LH) e induce ovulación. El precursor inmediato, la L-dopa, ha sido usado para inducir la ovulación y en el síndrome amenorrea-galactorrea, pero esta droga produce varios efectos indeseables. Por esta razón pareció conveniente investigar drogas capaces de elevar la DA cerebral con menos efectos colaterales. La acción del veneno de la serpiente Lachesis trigonocephalus sobre la DA cerebral fue estudiada en ratas Wistar. Treinta y nueve animales recibieron el veneno a una dinamización de 1 x 10-24 = 12CH en etanol al 22.5%. La droga fue administrada per os con un catéter a la dosis de 0.25 ml, con intervalos de 8 horas, durante 10 días. Treinta y tres ratas sirvieron como controles y recibieron la misma dosis de etanol sin la droga. El grupo control mostró un nivel medio de 998 ± 43 ng/g (X ± SE) y los animales que recibieron la droga 1136 ± 57 ng/g (P < 0.05). La concentración de noradrenalina (NA) fue de 528 ± 29 ng/g en el grupo control y de 452 ± 16 ng/g en el grupo que recibió Lachesis (P < 0.025). Los niveles de adrenalina no mostraron cambios significativos con la droga...

Dopamine (DA) stimulates hormone luteinizing liberator (LHR), increases hormone luteinizer (LH) and induces ovulation. L-Dopa, its immediate precursor, has been used to induce ovulation and in the amenorrhea-galactorrhea syndrome, but this drug produces several undesirable effects. It was therefore considered convenient to investigate drugs which can raise Brain DA with less side effects. The effect of Lachesis trigonocephalus snake poison was studied in rats. Thirty nine animals received the venom at a 1 x 10-24 dynamization (Lachesis trig. 12CH), in ethanol at 22.5%. The drug was administered per os through a catheter on a 0.25 ml dose, at 8 hour intervals during 10 days. Thirty three rats were used as controls and received the same dosage of ethanol without the drug. The control batch gave a mean level of 998 ± 29 ng/g (X ± SE) and animals which received the drug showed 1136 ± 57 ng/g (P < 0.025). The concentration of noradrenaline (NA) was 528 ± 29 ng/g in the group which received Lachesis trig. 12CH (P < 0.025). No significant variations of adrenaline levels were apparent with the drug...

Efecto de Lachesis trigonocephalus sobre dopamina cerebral en la rata / Lachesis trigonocephalus effect on dopamine in the rat brain

La dopamina (DA) estimula el factor liberador de hormona luteinizante (LHR), incrementa la hormona luteinizante (LH) e induce ovulación. El precursor inmediato, la L-dopa, ha sido usado para inducir la ovulación y en el síndrome amenorrea-galactorrea, pero esta droga produce varios efectos indeseables. Por esta razón pareció conveniente investigar drogas capaces de elevar la DA cerebral con menos efectos colaterales. La acción del veneno de la serpiente Lachesis trigonocephalus sobre la DA cerebral fue estudiada en ratas Wistar. Treinta y nueve animales recibieron el veneno a una dinamización de 1 x 10-24 = 12CH en etanol al 22.5%. La droga fue administrada per os con un catéter a la dosis de 0.25 ml, con intervalos de 8 horas, durante 10 días. Treinta y tres ratas sirvieron como controles y recibieron la misma dosis de etanol sin la droga. El grupo control mostró un nivel medio de 998 ± 43 ng/g (X ± SE) y los animales que recibieron la droga 1136 ± 57 ng/g (P < 0.05). La concentración de noradrenalina (NA) fue de 528 ± 29 ng/g en el grupo control y de 452 ± 16 ng/g en el grupo que recibió Lachesis (P < 0.025). Los niveles de adrenalina no mostraron cambios significativos con la droga. (AU)

Dopamine (DA) stimulates hormone luteinizing liberator (LHR), increases hormone luteinizer (LH) and induces ovulation. L-Dopa, its immediate precursor, has been used to induce ovulation and in the amenorrhea-galactorrhea syndrome, but this drug produces several undesirable effects. It was therefore considered convenient to investigate drugs which can raise Brain DA with less side effects. The effect of Lachesis trigonocephalus snake poison was studied in rats. Thirty nine animals received the venom at a 1 x 10-24 dynamization (Lachesis trig. 12CH), in ethanol at 22.5%. The drug was administered per os through a catheter on a 0.25 ml dose, at 8 hour intervals during 10 days. Thirty three rats were used as controls and received the same dosage of ethanol without the drug. The control batch gave a mean level of 998 ± 29 ng/g (X ± SE) and animals which received the drug showed 1136 ± 57 ng/g (P < 0.025). The concentration of noradrenaline (NA) was 528 ± 29 ng/g in the group which received Lachesis trig. 12CH (P < 0.025). No significant variations of adrenaline levels were apparent with the drug. (AU)

Acción de Lachesis trigonocephalus en diferentes potencias sobre las catecolaminas cerebrales / Lachesis trigonocephalus action in different potencies on brain catecholamines

Durante el Congreso Internacional del Centenario de la Escuela Libre de Homeopatía de México, celebrado en 2012, la doctora Josefina Sánchez Reséndiz presentó esta ponencia para hablar de los beneficios que la salud femenina puede tener gracias al uso de algunos medicamentos homeopáticos, en especial Lachesis trigonocephalus. De manera breve y precisa, la doctora Sánchez Reséndiz recordó los resultados de las investigaciones que realizó con el doctor Ángel Lerdo de Tejada y colaboradores sobre las catecolaminas cerebrales, partiendo de que la dopamina cerebral, a nivel del hipotálamo, tiene una gran influencia en la hormona luteinizante y en la conducta. Se pudo observar que el medicamento homeopático Lachesis trigonocephalus, a diferentes potencias, puede generar modificaciones estadísticamente significativas en las catecolaminas cerebrales, mecanismo por el cual, su uso podría ser capaz de mejorar los síntomas de la mujer durante el climaterio y la menopausia. (AU)

During the International Congress, in the 100th aniversary of the Escuela Libre de Homeopatía in Mexico, held in 2012, Josefina Sanchez Resendiz MD presented this conference to discuss about women’s health benefits that can be obtained by the use of some homeopathic medicines, especially Lachesis trigonocephalus. In a brief and precise way, Dr. Sanchez Resendiz recalled the results of the research conducted with Angel Lerdo de Tejada MD and collaborators on brain catecholamines, since brain dopamine in the hypothalamus, has a great influence in the luteinizing hormone its behavior. She observed that different potencies of the homeopathic remedy Lachesis trigonocephalus, can generate statistically significant changes in brain catecholamines. This could explain why its use may improve women’s symptoms during perimenopause and menopause. (AU)

Cambios observados en la concentración cerebral de catecolaminas, con Datura stramonium / Changes observed in brain catecholamine concentration, with Datura stramonium

Datura stramonium ha sido empleada empíricamente en la medicina tradicional mexicana desde antes de la conquista española, y después, a partir del siglo XVI, para diversos fines; entre otros datos se refiere que produce anorexia y agresividad. También se ha usado en la enfermedad de Parkinson. Con esos antecedentes se consideró de interés investigar el efecto de un extracto hidroalcohólico de esta planta sobre la concentración de dopamina (DA) cerebral en la rata. Se administró la substancia en estudio por medio de un catéter esofágico a la dosis de 0.25 ml/d a diferentes dinamizaciones. El grupo testigo mostró valores (X ± A) de 1197 ± 138 ng/g, y el que recibió la droga a la 12CH tuvo un promedio de 1607 ± 398 ng/g (p < 0.05). Las dinamizaciones más bajas (3CH y 6CH) produjeron elevaciones más moderadas, sin significación estadística. (AU)

Datura stramonium has been used empirically in ancient Mexican medicine and after the XVI century. It is known to produce anorexia and aggressiveness. It has also been used in Parkinson’s disease. For these reasons it seemed interesting to study the effect of different dynamizations of Datura stramonium on brain dopamine (DA) in the rat. The drug was administered by esophagic catheter at a dose of 0.25 ml/d. The control group showed values (X ± A) of 1197 ± 138 ng/g and the animals which received the extract at 12CH had a mean value of 1607 ± 398 ng/g (p < 0.05). The lower dynamizations (3CH and 6CH) induced more moderate increases without statistical significance. (AU)

Acute effects of restraint, shock and training in the elevated t-maze on noradrenaline and serotonin systems of the prefrontal cortex / Efectos agudos de la restricción, choque y entrenamiento en el laberinto elevado en T en los sistemas de noradrenalina y serotonina en la corteza prefrontal / Efeitos agudos da restrição, choque e treinamento no labirinto elevado em T nos sistemas de noradrenalina e serotonina no córtex pré-frontal

The prefrontal cortex (PFC) participates in cognitive functions and stress regulation. Noradrenaline (NA) and serotonin (5-HT) levels in some regions of the central nervous system are modified by acute stress. The effects depend on the type of stressor and the time elapsed between the presence of the stressor and the assessment. The aims of the present study were to assess the acute effect of different stressors on NA and 5-HT activities in the PFC and its relation with corticosterone levels. Independent groups of male Wistar rats (250-280 g) were submitted to restraint, footshock or training in the elevated T-maze (ETMT). The animals were sacrificed immediately (T0) or one hour (T1) after stress exposure. An untreated group sacrificed concurrently with treated animals was included as control. Samples of the PFC were dissected and the concentration of NA, 5-HT and their metabolites were measured by HPLC. Corticosterone levels were measured in serum. None of the treatments modified NA levels in the PFC. Animals exposed to footshock or ETMT showed significantly higher concentrations of 5-HT at T0. Restraint and footshock treatments were associated with higher corticosterone levels at T0 and T1 after the respective treatment. Taken together the results show that in the PFC, the noradrenergic and serotonergic systems, and the corticosterone levels respond in different ways to different stressors.

La corteza prefrontal (CPF) participa en las funciones cognitivas y la regulación del estrés. Las concentraciones de noradrenalina (NA) y serotonina (5-HT) en algunas regiones en el sistema nervioso central son modificadas por el estrés agudo. El efecto depende del estresor y del tiempo que transcurra entre el estresor y la evaluación. El objetivo del presente estudio fue evaluar el efecto agudo de diferentes estresores en la actividad de la NA y 5-HT en la CPF y su relación con los niveles de corticosterona. Grupos independientes de ratas (250-270 g) fueron sometidos a restricción, choque o entrenamiento en el laberinto elevado en T (ELET). Los animales fueron sacrificados inmediatamente (T0) o una hora (T1) después de la exposición al estrés. Un grupo no tratado, sacrificado al mismo tiempo que los animales tratados, se incluyó como control. Las muestras de la CPF fueron disecadas y la concentración de NA, 5-HT y sus metabolitos fue detectada por la técnica de HPLC. Las concentraciones de corticosterona fueron medidas en el suero. Ninguno de los tratamientos modificó las concentraciones de NA en la CPF. Al T0 los animales expuestos a choque o al ELET mostraron concentraciones de 5-HT significativamente mayores que el control. Los tratamientos de restricción y choque estuvieron asociados con altas concentraciones de corticosterona al T0 y a T1 después del tratamiento respectivo. En conjunto, los resultados mostraron que en la CPF los sistemas noradrenérgico y serotonérgico y la concentración de corticosterona responden en forma diferente a los distintos estresores.

O córtex pré-frontal (CPF) participa nas funções cognitivas e na regulação do estresse. As concentrações de noradrenalina (NA) e serotonina (5-HT) em algumas regiões do sistema nervoso central são modificadas pelo estresse agudo. O efeito depende do estressor e do tempo que transcorra entre o estressor e a avaliação. O objetivo do presente estudo foi avaliar o efeito agudo de diferentes estressores na atividade da NA e 5-HT no PFC e sua relação com os níveis de corticosterona. Grupos independentes de ratos (250-270 g) foram submetidos a restrição, choque ou treinamento no labirinto elevado em T (ELET). Os animais foram sacrificados imediatamente (T0) ou uma hora (T1) depois da exposição ao estresse. Um grupo não tratado, sacrificado ao mesmo tempo que os animais tratados, incluiu-se como controle. As mostras do PFC foram dissecadas e a concentração de NA, 5-HT e seus metabolitos foi detectada pela técnica de HPLC. As concentrações de corticosterona foram medidas no soro. Nenhum dos tratamentos modificou as concentrações de NA no PFC. Em T0 os animais expostos a choque o ao ELET mostraram concentrações de 5-HT significativamente maiores que o controle. Os tratamentos de restrição e choque estiveram associados com altas concentrações de corticosterona em T0 e em T1 depois do tratamento respectivo. Em conjunto, os resultados mostraram que no PFC os sistemas noradrenérgico e serotonérgico e a concentração de corticosterona respondem de maneira diferente aos diferentes estressores.

Atividade dos neurônios noradrenérgicos do Locus coeruleus e o conteúdo de GnRH em ratas wistar acíclicas / Activity of the Locus Coeruleus noradrenergic neurons and the GnRH content in female acyclic rats

As alterações nos componentes reprodutivos do eixo hipotálamo-hipófise-gônadas em muitas fêmeas de mamíferos determinam a transição gradual de ciclos reprodutivos regulares para ciclos irregulares, com perda de fertilidade. A interação dos neurônios do hormônio liberador de gonadotrofinas (GnRH) e esteróides gonadais representa função chave na neurobiologia do envelhecimento, pois a sobreposição temporal da senescência endócrina e neural está mecanicamente interligada pelas alças de retroalimentação. Estímulos do locus coeruleus (LC) para a área pré-óptica (APO) e eminência mediana são essenciais para a liberação das gonadotrofinas e seus neurônios apresentam receptores para estrógeno e progesterona, sugerindo controle dos esteróides ovarianos. Neste estudo foi avaliado a atividade de células neuronais localizadas em áreas e núcleos envolvidos com o controle de ação dos neurônios GnRH de ratas Wistar no período de transição para a aciclicidade. Para este trabalho foram utilizadas fêmeas Wistar cíclicas (4 meses) e acíclicas (18-20 meses) submetidas à decapitação ou perfusão às 10, 14 e 18 h na fase do diestro. Após serem retirados, os cérebros dos animais decapitados foram congelados e armazenados para posterior determinação do conteúdo de GnRH hipotalâmico e do conteúdo de noradrenalina e dopamina na APO. Os cérebros perfundidos foram cortados seriadamente em secções coronais de 30 μm para a APO e o LC e posteriormente submetidos à marcação imunohistoquimica para Fos (FRA) e FRA/TH, respectivamente. Para análise quantitativa da APO foram considerados os plates que contêm o AVPe sendo a contagem dos neurônios FRA-ir realizada a partir da inserção de caixa com diâmetro variando em função da altura do 3º ventrículo e para o LC foram considerados somente os neurônios duplamente marcados para FRA/TH. Em todas as análises foram considerados os plates comuns a todos os animais. O plasma dos animais experimentais foi utilizado para as dosagens de LH, FSH, PRL...

Changes in reproductive components of the hypothalamic-pituitary-gonadal axis in many female mammals determine the gradual transition from regular reproductive cycles to irregular cycles, with loss of fertility. The interaction of neurons of gonadotropin-releasing hormone (GnRH) and gonadal steroids represents key role in the neurobiology of aging, because the temporal overlap of endocrine and neural senescence is mechanically interconnected by feedback loops. Stimulation of the locus coeruleus (LC) for the preoptic area (POA) and median eminence are essential for the release of gonadotropins and their neurons have receptors for estrogen and progesterone, suggesting control of ovarian steroids. Therefore, in this study we evaluated the activity of neuronal cells located in areas and nuclei involved in the control of action of GnRH neurons of female rats during the transition to acyclicity. For this study, we used cyclic female (4 months) and acyclic (18-20 months) rats underwent perfusion or decapitation at 10, 14 and 18 h of diestrus day. The brains from decapitated animals, after removed, were frozen and stored for subsequent determination of the hypothalamic GnRH content and the noradrenaline and dopamine content in the POA. The perfused brains were serially cut into coronal sections of 30 μm to POA and LC and subsequently submitted to immunohistochemical labeling for Fos (FRA) and FRA / TH, respectively. For quantitative analysis of the POA were considered plates containing AVPe being the counting of neurons FRA-ir performed from the insertion of the box with a diameter varying depending on the height of the 3rd ventricle and the LC were considered only neurons doubly labeled for FRA / TH. In all analyzes were considered plates common to all animals. The plasma of the experimental animals was used for the assay of LH, FSH, PRL and gonadal steroids. The GnRH content and LH concentrations of the acyclic rats were smaller and constant at the time intervals...

Gangrena simétrica periférica vinculada a coagulación intravascular diseminada, shock séptico e infusión de noradrenalina / Symmetric peripheral gangrene linked to coagulation disseminated intravascular septic shock and infusion of noradrenaline

Introducción: Los intensivistas se enfrentan habitualmente con cuadros clínicos que pueden producir el síndrome de gangrena simétrica periférica. Al reconocer esta posibilidad, pueden prevenirlo, atenuarlo o revertirlo y reducir la morbimortalidad. Presentación del caso: Varón de 34 años con antecedentes de alcoholismo que se presenta con sepsis grave secundaria a absceso de pulmón derecho. Evolucionó con coagulación intravascular diseminada, requirió altas dosis de noradrenalina y tuvo gangrena acral en las cuatro extremidades. Finalmente falleció. Conclusiones: La combinación de shock e hipoperfusión, altas dosis de vasopresores y coagulación intravascular diseminada se vincula con la gangrena simétrica periférica que sufrió nuestro paciente. El manejo terapéutico de la gangrena simétrica periférica es multidisciplinario. (AU)

Introduction: Intensivists are confronted regularly with clinical and therapeutic conditions that can produce symmetrical peripheral gangrene syndrome. Knowing this possibility, they may prevent, attenuate and/or reverse it, and reduce its morbidity and mortality. Case presentation: A 34 years old man with history of alcoholism who presented with severe sepsis due to right lung abscess. The patient developed disseminated intravascular coagulation, he required high doses of noradrenaline infusion and he had acral gangrene in the four limbs. Finally he died. Conclusions: The combination of shock and hypoperfusion, high doses of vasopressors and disseminated intravascular coagulation is associated with the symmetrical peripheral gangrene presented by our patient. The therapeutic management of the symmetrical peripheral gangrene is multidisciplinary.(AU)

Endofenotipos de Distimia: uso racional de psicofármacos / Endophenotypes of Dysthymia: rational use of psychiatric drugs

El trastorno distímico es una patología subdiagnosticada, que genera un malestar clínicamente significativo con deterioro social, laboral o de otras áreas importantes de la actividad de un individuo. La interrelación entre la genética y la influencia ambiental hace que surjan determinadas etiologías de un trastorno psiquiátrico, que se manifiestan con características clínicas diferentes. A éstas las llamamos ¶características endofenotípicas÷. El endofenotipo determinará también una genética psiquiátrica particular, resultante de la relación que haya entre éste y el pool génico del individuo en cuestión, como así también una respuesta a los fármacos utilizados durante el tratamiento. En la Distimia el afrontamiento maladaptativo es un síntoma central; genera sentimientos negativos llevando a la deserción, fracaso o aumento de la respuesta fisiológica al estrés. La diferente modalidad de afrontamiento, predominando o no la ansiedad como síntoma capital, genera dos endofenotipos de esta patología: Distimia Ansiosa (con ansiedad) y Distimia Anérgica (sin ansiedad). Entre los endofenotipos, las diferencias se reflejan en tratamientos específicos: para la Distimia Anérgica se debe modular el sistema noradrenalina/dopamina. Los IRSS no serían la primera elección. Sí, en cambio, fármacos como el bupropion, la venlafaxina, la amisulprida y los antidepresivos tricíclicos; en la Distimia Ansiosa, se deben utilizar antidepresivos que mejoren la neurotransmisión noradrenérgica/serotoninérgica; los Inhibidores de la Recaptación de la Serotonina y la Noradrenalina (SNRI) tienen una mejor respuesta que los Inhibidores Selectivos de la Recaptación de la Serotonina (IRSS), aunque estos también otorgan una buena alternativa.(AU)

Dysthymic disorder is an underdiagnosed pathology characterized by clinically significant distress, and impairment in the social, occupational, or other important areas of activity of an individual. The inter relationship between genetics and the environmental influence cause the emergence of certain etiologies from a psychiatric disorder, which manifest with different clinical characteristics. These are called "endophenotypic characteristics". The endophenotype will also determine a particular psychiatric genetics, which results from the relationship between it and the gene pool of the individual in question, as well as a response to the psychiatric drugs used during the treatment. Within dysthymia, maladaptive coping is a central symptom, it generates negative feelings that led to desertion, failure, or to an increase in the physiological response to stress. Each coping modality, whether anxiety prevails as the central symptom or not, generates two endophenotypes of this pathology: anxious dysthymia (dysthymia with anxiety) and Anergic Dysthymia (dysthymia without anxiety). Among the endophenotypes, differences are reflected in specific treatments: in the case of Anergic Dysthymia, the noradrenaline/dopamine system has to be modulated. SSRls would not be the firest choice, but rather, drugs such as bupropion, venlafaxine, amisulpride and tryciclic antidepressants, for the treatment of Anxious Dysthymia, antidepressants have to be used that imporve the noradrenergic/serotoninergic neurotransmission, Serotonin and Noradrenalin Reuptake inhibitors (SNRIs) have a better response than Selective Serotonin Repuptake Inhibitors (SSRIs) have a better response than Selective Serotonin Reuptake Inhibitors (SSRIs), although the latter also provide a good alternative.(AU)

Endofenotipos de Distimia: uso racional de psicofármacos / Endophenotypes of Dysthymia: rational use of psychiatric drugs

El trastorno distímico es una patología subdiagnosticada, que genera un malestar clínicamente significativo con deterioro social, laboral o de otras áreas importantes de la actividad de un individuo. La interrelación entre la genética y la influencia ambiental hace que surjan determinadas etiologías de un trastorno psiquiátrico, que se manifiestan con características clínicas diferentes. A éstas las llamamos “características endofenotípicas”. El endofenotipo determinará también una genética psiquiátrica particular, resultante de la relación que haya entre éste y el pool génico del individuo en cuestión, como así también una respuesta a los fármacos utilizados durante el tratamiento. En la Distimia el afrontamiento maladaptativo es un síntoma central; genera sentimientos negativos llevando a la deserción, fracaso o aumento de la respuesta fisiológica al estrés. La diferente modalidad de afrontamiento, predominando o no la ansiedad como síntoma capital, genera dos endofenotipos de esta patología: Distimia Ansiosa (con ansiedad) y Distimia Anérgica (sin ansiedad). Entre los endofenotipos, las diferencias se reflejan en tratamientos específicos: para la Distimia Anérgica se debe modular el sistema noradrenalina/dopamina. Los IRSS no serían la primera elección. Sí, en cambio, fármacos como el bupropion, la venlafaxina, la amisulprida y los antidepresivos tricíclicos; en la Distimia Ansiosa, se deben utilizar antidepresivos que mejoren la neurotransmisión noradrenérgica/serotoninérgica; los Inhibidores de la Recaptación de la Serotonina y la Noradrenalina (SNRI) tienen una mejor respuesta que los Inhibidores Selectivos de la Recaptación de la Serotonina (IRSS), aunque estos también otorgan una buena alternativa.

Dysthymic disorder is an underdiagnosed pathology characterized by clinically significant distress, and impairment in the social, occupational, or other important areas of activity of an individual. The inter relationship between genetics and the environmental influence cause the emergence of certain etiologies from a psychiatric disorder, which manifest with different clinical characteristics. These are called "endophenotypic characteristics". The endophenotype will also determine a particular psychiatric genetics, which results from the relationship between it and the gene pool of the individual in question, as well as a response to the psychiatric drugs used during the treatment. Within dysthymia, maladaptive coping is a central symptom, it generates negative feelings that led to desertion, failure, or to an increase in the physiological response to stress. Each coping modality, whether anxiety prevails as the central symptom or not, generates two endophenotypes of this pathology: anxious dysthymia (dysthymia with anxiety) and Anergic Dysthymia (dysthymia without anxiety). Among the endophenotypes, differences are reflected in specific treatments: in the case of Anergic Dysthymia, the noradrenaline/dopamine system has to be modulated. SSRls would not be the firest choice, but rather, drugs such as bupropion, venlafaxine, amisulpride and tryciclic antidepressants, for the treatment of Anxious Dysthymia, antidepressants have to be used that imporve the noradrenergic/serotoninergic neurotransmission, Serotonin and Noradrenalin Reuptake inhibitors (SNRIs) have a better response than Selective Serotonin Repuptake Inhibitors (SSRIs) have a better response than Selective Serotonin Reuptake Inhibitors (SSRIs), although the latter also provide a good alternative.