Estado del arte del síndrome cardiorrenal, ventajas y limitaciones de las terapias conocidas / State of the art of cardiorenal syndrome, advantages and limitations of known therapies

Resumen Las interacciones entre las enfermedades cardiacas y las renales se han clasificado como síndromes cardiorrenales. La clasificación actual incluye cinco subtipos: insuficiencia cardiaca aguda que conduce a insuficiencia renal aguda (tipo 1), insuficiencia cardiaca crónica que conduce a insuficiencia renal (tipo 2), lesión renal aguda que conduce a insuficiencia cardiaca (tipo 3), enfermedad renal crónica que conduce a insuficiencia cardiaca (tipo 4) y afecciones sistémicas que conducen a insuficiencia cardiaca y renal (tipo 5) (tabla 1)1,2. En esta revisión discutimos la definición, la clasificación y la fisiopatología del síndrome cardiorrenal, enfocándonos en el manejo en fases agudas y su recuperación, al exponer la evidencia actualmente disponible de los diuréticos y la ultrafiltración, con el objetivo de intervenir de manera oportuna a nuestros pacientes al conocer las ventajas y las limitaciones de cada una de las estrategias de manejo en aras de reducir el riesgo de eventos clínicos, rehospitalización y muerte.

Abstract Interactions between heart and kidney disease have been classified as cardiorenal syndromes. The current classification includes five subtypes, which are: acute heart failure leading to acute kidney failure (type 1), chronic heart failure leading to kidney failure (type 2), acute kidney injury leading to heart failure (type 3), chronic kidney disease leading to heart failure (type 4) and systemic conditions leading to heart and kidney failure (type 5) (table 1)1,2. In this review, we discuss the definition, classification, pathophysiology, focusing on acute phases treatment and its recovery, exposing the actual evidence for diuretics and ultrafiltration in order to intervene in a timely manner, pointing out the main advantages and limitations of each of the available strategies of treatment in order to reduce the risk of clinical events, re-hospitalization and death.

Thiazide and thiazide-like diuretics in nephrolithiasis / Diuréticos tiazídicos e tiazídicos-like na nefrolitíase

Abstract Thiazide and thiazide-like diuretics are widely used for the management of hypercalciuria among stone-forming patients. Although the effects of different thiazides should be relatively similar in terms of prevention of stone recurrence, their potency and side effects may differ. However, there is scarce data concerning the metabolic and bone effects of these agents among recurrent nephrolithiasis patients with hypercalciuria. The aim of this update article was to compare our experience in the use of thiazide and thiazide- like diuretics with that of the current literature, concerning their anticalciuric properties and consequent reduction of recurrent stone formation. Their impact on bone mass and potential side effects were also discussed.

Resumo Diuréticos tiazídicos e tiazídicos-like são amplamente usados para o tratamento da hipercalciúria em pacientes com formação de cálculos. Embora os efeitos dos diferentes tiazídicos devam ser relativamente semelhantes em termos de prevenção da recorrência do cálculo, sua potência e efeitos colaterais podem ser diferentes. No entanto, há poucos dados sobre os efeitos metabólicos e ósseos desses agentes em pacientes com nefrolitíase recorrente com hipercalciúria. O objetivo deste artigo de atualização foi comparar nossa experiência quanto ao uso de tiazídicos e tiazídicos-like com a publicada na literatura atual, no que diz respeito às suas propriedades anticalciúricas e consequente redução da formação de cálculos recorrentes. Discutimos também seu impacto na massa óssea e potenciais efeitos colaterais.

Early urinary sodium trajectory and risk of adverse outcomes in acute heart failure and renal dysfunction.

INTRODUCTION AND OBJECTIVES: Urinary sodium (UNa+) has emerged as a useful biomarker of poor clinical outcomes in acute heart failure (AHF). Here, we sought to evaluate: a) the usefulness of a single early determination of UNa+ for predicting adverse outcomes in patients with AHF and renal dysfunction, and b) whether the change in UNa+ at 24hours (ΔUNa24h) adds any additional prognostic information over baseline values. METHODS: This is a post-hoc analysis of a multicenter, open-label, randomized clinical trial (IMPROVE-HF) (ClinicalTrials.gov NCT02643147) that randomized 160 patients with AHF and renal dysfunction on admission to a) the standard diuretic strategy, or b) a carbohydrate antigen 125-guided diuretic strategy. The primary end point was all-cause mortality and total all-cause readmissions. RESULTS: The mean age was 78±8 years, and the mean glomerular filtration rate was 34.0±8.5mL/min/1.73 m2. The median UNa+ was 90 (65-111) mmol/L. At a median follow-up of 1.73 years [interquartile range, 0.48-2.35], 83 deaths (51.9%) were registered, as well as 263 all-cause readmissions in 110 patients. UNa+ was independently associated with mortality (HR, 0.75; 95%CI, 0.65-0.87; P <.001) and all-cause readmissions (HR, 0.92; 95%CI, 0.88-0.96; P <.001). The prognostic usefulness of the ΔUNa24h varied according to UNa+ at admission (P for interaction <.05). The ΔUNa24h was inversely associated with both end points only in the group with UNa+ ≤ 50 mmol/L. Conversely, no effect was found in the group with UNa+> 50 mmol/L. CONCLUSIONS: In patients with AHF and renal dysfunction, a single early determination of UNa+ ≤ 50 mmol/L identifies patients with a higher risk of all-cause mortality and readmission. The ΔUNa24h adds prognostic information over baseline values only when UNa+ at admission is ≤ 50 mmol/L.

Diuretic treatment of the patient with diabetes and heart failure. Role of SGLT2 inhibitors and similarities with carbonic anhydrase inhibitors. / Tratamiento diurético del paciente con diabetes e insuficiencia cardiaca. El papel de los inhibidores de la SGLT2 y semejanzas con los inhibidores de la anhidrasa carbónica.

Sodium-glucose cotransporter-2 inhibitors have changed the concept of the effects that hypoglycemic drugs have on hearth failure (HF). For the first time, a therapeutic group has modified the evolution of HF. Its effect goes beyond glycemic control, and different theories have been postulated to justify this benefit. In the article we sent, we analyze the influence of the different pharmacological groups used in type 2 diabetes mellitus on HF, and we present the theory of the mechanism of action associated with the benefit of these drugs. In our opinion, this benefit in HF is secondary to its diuretic effect, specifically an effect very similar to carbon dioxide inhibitors. We think that our theory is novel, explains the mechanism of action and we have not found in the literature any article that explains the mechanism of action in such a precise way.

Evaluation of antimicrobial, hypotensive and diuretic effect of Eugenia uniflora extracts / Avaliação do efeito antimicrobiano, hipotensivo e diurético de extratos de Eugenia uniflora

The genus Eugenia sp. (Myrtaceae) comprises plants with reported antioxidant and antidiarrheal capability among other therapeutic potentials. The aim of this study was to evaluate the antimicrobial activity of essential oil; diuretic and hypotensive activities of aqueous extracts from leaves of Eugenia uniflora. The antimicrobial activity was evaluated . The diuretic and hypotensive activities were evaluated in normotensive Wistar rats by measuring blood pressure and urine flow after received four different concentrations of aqueous extracts (10%, 15%, 20% and 25%). Essential oil inhibited the growth of Candida parapsilosis and Candida albicans with MIC values lower than 14.41 mg/mL, equal to 57.75 mg/mL for Candida krusei. Among antibacterial effect, essential oil inhibited growth with a MIC equals to 153.93 mg/mL for all strains tested, except for Escherichia coli (MIC equals to 307.96 mg/mL. Aqueous extracts showed powerful reductions of the arterial pressure (34% and 31% lower than the control), after administration of 10% and 25% of aqueous extract, respectively. However, the animals that received the aqueous extract at the 15% and 20% concentrations presented a discrete hypotensive effect (20% and 21% lower than control group, respectively) concomitantly to powerful diuretic effect (280% and 91% higher than control group, respectively). These data confirmed the potential biological effect of this species, and represents an important step toward a depth study on the therapeutic properties of this species

O gênero Eugenia sp. (Myrtaceae) compreende plantas com capacidade antimicrobiana e antioxidante entre outros potenciais terapêuticos. O objetivo deste estudo foi avaliar a atividade antimicrobiana de óleo essencial; atividade diurética e hipotensora de extrato aquoso de folhas de Eugenia uniflora. A atividade antimicrobiana foi avaliada pela determinação da concentração inibitória mínima (MIC) e concentração mínima bactericida (MBC) de cepas bacterianas e concentração fungicida mínima (MFC) para fungos. A atividade diurética e hipotensora foi avaliada em ratos Wistar normotensos pela mensuração da pressão sanguínea e fluxo urinário após administração de quatro diferentes concentrações de extrato aquoso (10%, 15%, 20% e 25%). Óleo essencial inibiu o crescimento de Candida parapsilosis e Candida albicans com valores de MIC menores que 14,41 mg/mL, igual a 57,75 mg/mL para Candida krusei. A respeito do efeito antimicrobiano, o óleo essencial inibiu o crescimento de todas as cepas testadas, com MIC igual a 153,93 mg/mL, exceto para Escherichia coli (MIC igual a 307.96 mg/mL). O extrato aquoso mostrou redução importante da pressão arterial (34% e 31% quando comparado ao controle), após administração de 10% e 25% do extrato aquoso, respectivamente. Contudo, os animais que receberam o extrato aquoso na concentração de 15% e 20% apresentaram discreto efeito hipotensor (20% e 21% menor que o grupo controle, respectivamente) concomitantemente ao importante efeito diurético (280% e 91% maior quando comparado ao grupo controle, respectivamente). Esses achados confirmam o potencial efeito biológico dessa espécie, e representa um importante embasamento para estudos relacionados as propriedades terapêuticas da Eugenia uniflora

Prescripciones de diuréticos de asa potencialmente inapropiadas en ancianos / Potentially inappropriate loop diuretic prescriptions in the elderly

Resumen Objetivo: Identificar la prescripción potencialmente inadecuada de diuréticos de asa como monoterapia de primera línea en hipertensión arterial de pacientes mayores de 65 años en Colombia. Métodos: Estudio cuasiexperimental, prospectivo, antes y después, sin grupo control, mediante una intervención educativa dirigida a prescriptores de pacientes mayores de 65 años con diagnóstico de hipertensión arterial en manejo con furosemida en monoterapia, afiliados al régimen pago del Sistema de Salud de Colombia entre el 1◦. de enero y el 30 de agosto de 2014. Luego de la identificación de los pacientes de una base de datos poblacional de dispensación de medicamentos y de la intervención se midió el cambio en la formulación. Resultados: De un total de 453.017 sujetos en tratamiento antihipertensivo se identificaron 160 pacientes con diagnóstico de hipertensión arterial tratados con furosemida en monoterapia, con una edad media de 82,7 ± 9,1 años. Se realizaron 76 actividades educativas sobre los médicos y se consiguió modificar la terapia en 67 pacientes (41,8% de los intervenidos), donde el 6,8% suspendió el diurético, pero inició un nuevo antihipertensivo, 13,1% agregó un antihipertensivo y 21,8% lo suspendió definitivamente. Ser anciano entre 65 y 74 años se asoció con mayor probabilidad de éxito en la intervención (OR: 2,2; IC95%:1,010-4,860; p < 0,001). Conclusiones: Una pequeña proporción de pacientes mayores de 65 años son tratados con furosemida en monoterapia antihipertensiva, pero las estrategias educativas y de seguimiento de las prescripciones pueden reducir su uso inapropiado. Es importante desarrollar herramientas que incentiven al médico a evitar prescripciones menos eficaces y seguras.

Abstract Motivation: To identify the potentially inappropriate prescription of loop diuretics as a first-line monotherapy in arterial hypertension of patients over 65 years old in Colombia. Methods: Quasiexperimental, prospective, before and after study, without a control group, by means of an educational intervention aimed at prescriptors of patients over 65 years old with the diagnosis of arterial hypertension managed with furosemide in monotherapy, affiliated to the Colombian Health System between January 1st and August 30th 2014. After identifying the patients in a population database of medication dispensation and after the intervention, changes in the formulation were measured. Results: Out of a total of 453,017 individuals taking antihypertensives, 160 patients were identified with arterial hypertension being treated with furosemide in monotherapy, with an average age of 82.7 ± 9.1 years. 76 educational activities were carried out with physicians and therapy could be modified in 67 patients (47.8% of intervention participants), where 6.8% discontinued the diuretic, but initiated a new antihypertensive, 13.1% added an antihypertensive and 21.8% definitely suspended the treatment. Being between 65 and 74 years old was associated to a higher probability of success of the intervention (OR: 2.2; CI 95%: 1.010-4.860; p < 0.001). Conclusions: A small proportion of patients over 65 years of age were treated with furosemide as antihypertensive monotherapy, but educational strategies and monitorisation of prescriptions may reduce their inappropriate use. It is important to develop tools to motivate the physician to avoid less efficient and safe prescriptions.

Hyponatraemia and congestive heart failure refractory to diuretic treatment. Utility of tolvaptan. / Hiponatremia e insuficiencia cardiaca congestiva refractaria a tratamiento diurético. Utilidad del tolvaptán.

Heart failure (HF) is currently one of the most significant healthcare problems in Spain and has a continuously increasing prevalence. Advances in our understanding of the various biological responses that promote cardiac remodelling and pulmonary venous congestion constitute the basis of current treatment. This article, prepared by members of the HF groups of the Spanish Society of Cardiology and the Spanish Society of Internal Medicine, discusses the current therapeutic strategies for patients with congestion refractory to diuretic treatment. The article includes our clinical experience with the use of tolvaptan as an additional treatment for congestion associated with hyponatraemia. To this end, we propose an algorithm for the use of tolvaptan in patients with congestive HF, natraemia <130mEq/l and poor response to conventional diuretic treatment.

Diálisis peritoneal paliativa en pacientes con falla cardiaca sin enfermedad renal terminal / Palliative peritoneal dialysis in patients with heart failure without end-stage renal Failure

Resumen Dentro de los grandes problemas que se tienen en falla cardiaca, el manejo del volumen en algunos de los pacientes resulta muy difícil y ocasionalmente puede producir grandes alteraciones renales, por lo cual ha sido una de las principales preocupaciones dentro de las estrategias terapéuticas. La diálisis peritoneal ha surgido como una estrategia en algunos pacientes con presencia de disfunción ventricular y de disfunción renal; sin embargo, hay un grupo de pacientes en los cuales el deterioro de la función renal no es severo, pero hay imposibilidad para el manejo óptimo con diuréticos a dosis más altas y hay necesidad de mayor manejo de volumen. La diálisis peritoneal ha evidenciado beneficios clínicos, entre los cuales se encuentra la posibilidad de manejo ambulatorio, el cambio de su clase funcional de III/IV a I/II, la mejoría de la calidad de vida, la reducción en los días de hospitalización o el aumento de la función renal. Se ha realizado una revisión de este escenario específico con presentación de los primeros casos que se han dispuesto con esta finalidad en la clínica de falla cardíaca de la Fundación Cardiovascular de Colombia.

Abstract Within the great problems of heart failure, the management of volume in some of the patients is a difficult task and could occasionally produce severe renal alterations, thus becoming one of the main worries when it comes to therapeutic strategies. Peritoneal dialysis has emerged as a strategy in some patients with ventricular dysfunction and renal dysfunction; however, there is a group of patients where the deterioration of renal function is not severe, but there is an impossibility of optimal management with diuretics at higher doses and there is a need for a greater volume management. Peritoneal dialysis has evidenced clinical benefits, among which there is the possibility of outpatient management, the change from functional class III/IV to I/II, the improvement in quality of life, the decrease of hospitalization days or the increase in renal function. A review of this specific scenario with the presentation of the first cases that have been managed with this motivation in the heart failure clinic of the Cardiovascular Foundation of Colombia is conducted.

Edema idiopático. Presentación de un caso y revisión de la literatura / Idiopathic edema. Case report and literature review

El edema idiopático es un diagnóstico de exclusión, caracterizado por la acumulación de líquido en tejido intersticial en mujeres premenopáusicas en ausencia de patología cardiaca, renal o hepática. Típicamente los laboratorios y estudios complementarios son normales. El tratamiento es la Espironolactona debido al Hiperaldosteronismo secundario concomitante. De no ser efectivo, puede ser añadido o cambiado a un diurético tiazídico a la menor dosis efectiva. Es frecuente la resistencia a este grupo farmacológico.

Idiopathic edema is a diagnosis of exclusion, characterized by the accumulation of fluid in interstitial tissue in premenopausal women in the absence of cardiac, renal or hepatic pathology. Typically laboratories and complementary studies are normal. Treatment is Spironolactone due to concomitant secondary hyperaldosteronism. If not effective, it can be added or changed to a thiazide diuretic at the lowest effective dose. Resistance to this pharmacological group is frequent.

Eritrodermia deccamativa agresiva, reacción advrsa en paciente tratado con hiddroclorotiazida: reporte de caso / Aggressive scaly erytroderma, adverse reaction ina patient treated with hydrochllorothiazide: a case report

Se describe un caso clínico de un hombre de 69 años, hipertenso que recibió tratamiento con hidroclorotiaziada 25 mg día y desarrolló una reacción adversa compatible con una eritrodermia descamativa. El paciente experimentó mejoría clínica y resolución total de sus problemas cutáneos cuando finalizó el uso de la hidroclorotiazida.

The clinical case of a 69 year old man having high blood pressure who was treated with hydrochlorothiazide at 25 mg per day and who developed an adverse reaction compatible with scaly erythroderma is described. The patient underwent clinical recovery and total solution to his skin problems when the use of hydrochlorothiazide was susupended.

Diuretic effect of alkaloids fraction extracted from Selaginella lepidophylla (Hook. et Grev.) Spring / Efecto diurético de la fracción con contenido de alcaloides extraída deSelaginella lepidophylla (Hook. et Grev.) Spring

The aerial parts of Selaginella lepidophylla (Hook. et Grev.) Spring, are used in Mexican folk medicine to treat renal diseases. The aim of this study was to measure the diuretic response of an aqueous extract (200 mg/kg) and alkaloids fraction at different doses (10, 40 y 100 mg/kg) of this plant and compare it with that induced by furosemide (4 mg/kg). Extract, alkaloids fraction, furosemide and vehicle were administered orally to adult rats and the effects in sodium, potassium and water balance were measured. The extract, the alkaloids fraction and the furosemide produced important and significant increments in urinary excretion of sodium, potassium and water with respect to control group. This increment was dose dependent of the alkaloids fraction, the highest dose produced a major effect. Potassium excretion increased but it was less than the one induced by furosemide. These results suggest that the aqueous extract and rich fraction in alkaloids from S. lepidophylla induce diuretic response.

Las partes aéreas de Selaginella lepidophylla (Hook. et Grev.) Spring, son usadas en la medicina tradicional mexicana para tratar enfermedades renales. El objetivo del estudio fue medir la respuesta diurética de un extracto acuoso (200 mg/kg) y de diferentes dosis de la fracción de alcaloides (10, 40 y 100 mg/kg) de esta planta y compararla con la inducida por furosemida (4 mg/kg). El extracto, la fracción de alcaloides, la furosemida y el vehículo fueron administrados por vía oral a ratas adultas y se midieron los efectos en el balance de sodio, potasio e hídrico. El extracto, la fracción de alcaloides y la furosemida produjeron importantes y significativos incrementos en la excreción urinaria de sodio, potasio y agua con respecto al grupo testigo. Este incremento fue dependiente de la dosis de la fracción de alcaloides, la dosis más alta produjo el mayor efecto. El incremento en la excreción de potasio fue menor al de furosemida. Los resultados sugieren que el extracto acuoso y la fracción rica en alcaloides de S. lepidophylla inducen una respuesta diurética.

Valoración dosis-respuesta del efecto diurético de un extracto acuoso de pericarpio de Cucumis melo var. reticulatus Ser. / Dose-response assessment of the diuretic effect in a pericarp aqueous extract of Cucumis melo L. var. reticulatus Ser.

Introducción: la investigación se realizó para determinar la relación dosis-respuesta del pericarpio de melón, validar su empleo en la medicina tradicional venezolana y promover su uso racional como planta medicinal, mediante el conocimiento científico. Objetivo: valorar la relación dosis-respuesta del efecto diurético de la concha del fruto de Cucumis melo var. reticulatus Ser. en ratas. Métodos: se licuó el pericarpio del fruto fresco y se colocó en solución fisiológica por 48 h para luego colarlo. Se administraron vía oral dosis de 1, 3 y 6 mL/300 g, se compararon con un grupo control respectivo y se midió el volumen de orina producido transcurrida 1 h. Resultados: la primera dosis no tuvo efecto diurético en ningún caso. La excreción urinaria de las 2 mayores dosis fue diferente de su respectivo grupo control. Los grupos tratados con extracto acuoso a 3 y 6 mL resultaron diferentes entre sí, igual que los grupos control a esos volúmenes. No se encontró diferencia en la acción diurética. Se halló una relación dosis-respuesta de regresión no-lineal. Conclusiones: se evidencia la relación dosis-respuesta basada en la excreción urinaria, tras administrar el extracto acuoso de la concha de melón, lo que sustenta su empleo como diurético en la medicina tradicional venezolana.

Introduction: research was conducted to determine the dose-response of melon pericarp, validate its use in traditional medicine in Venezuela and promote its rational use as a medicinal plant, through scientific knowledge. Objective: to assess the dose-response diuretic effect of the shell of the fruit of Cucumis melo var. reticulatus Ser. in rats. Methods: fresh fruit pericarp was liquefied and placed in saline solution for 48 hours to strain it later. Oral doses of 1, 3 and 6 mL/300g were administered, compared with a respective control group, and the volume of urine produced an hour later was measured. Results: the first dose had no diuretic effect in any case. Urinary excretion of the two higher doses differed from their respective control group. The groups treated with aqueous extract at 3 and 6 mL were different among them, as well as the control groups in those volumes. No difference was found in the diuretic action. The study found a dose-response of nonlinear regression. Conclusions: there is a clear dose-response relationship based on urinary excretion after administration of the aqueous extract of melon shell, which supports its use as a diuretic in traditional medicine in Venezuela.

Hipertensión Arterial Resistente / Resistant hypertension

Se define a la hipertensión resistente como la presión arterial que se mantiene por encima de los niveles establecidos a pesar de estar usándose tres medicamentos antihipertensivos en dosis óptimas; y una de estas tres drogas debiera ser un diurético. Los pacientes cuya presión arterial se mantiene controlada pero que requieran 4 o más medicamentos también son considerados como resistentes al tratamiento. Los análisis realizados en estudios a gran escala de medicamentos antihipertensivos apuntan a una prevalencia de 10 a 20% para la hipertensión resistente al tratamiento en la población general de hipertensos. Los pacientes con hipertensión resistente tienen una probabilidad de 50% o más de experimentar un evento adverso cardiovascular en comparación con aquellos con hipertensión controlada que están usando tres o menos agentes antihipertensivos. Los estudios indican que un 5 a un 10% de los pacientes con hipertensión resistente tienen una causa secundaria subyacente para su presión arterial elevada, una prevalencia significativamente mayor comparada con lo observado en la población general de hipertensos. La mejor evidencia disponible sustenta el empleo de espironolactona en dosis bajas como el cuarto medicamento antihipertensivo preferible si los niveles séricos de potasio de los pacientes estuvieran bajos. Si tales valores fueran más elevados, deberá considerarse una intensificación de una terapia con diuréticos del grupo de las tiazidas. La terapia de denervación simpática renal, siendo una intervención invasiva, potencialmente podría estimular un cambio de paradigmas en el manejo de la hipertensión resistente.

Resistant hypertension is defined as blood pressure that remains above target in spite of using three optimally dosed antihypertensive drugs of different classes, and one of the three drugs should be a diuretic. Patients whose blood pressure is controlled but requiring 4 or more drugs are also considered as resistant to treatment. Analyses of large scale trials of antihypertensive drugs point to a 10-20% prevalence of resistant hypertension in the general hypertensive population. Patients with resistant hypertension are almost 50% more likely to experience an adverse cardiovascular event compared with those with controlled blood pressure using three or less antihypertensive agents. Studies indicate that 5-10% of patients with resistant hypertension have an underlying secondary cause for their elevated blood pressure - a prevalence significantly greater compared to that of the general hypertensive population. The best available evidence supports the use of low dose spironolactone as the preferred fourth antihypertensive drug if the patient's blood potassium level is low. With higher blood potassium levels, intensification of thiazide-like diuretic therapy should be considered. Renal sympathetic denervation therapy, as a device based intervention, could potentially stimulate a paradigm shift in the management of resistant hypertension.

Efeitos da inalação de beclometasona e furosemida sobre a função pulmonar e índice de oxigenação de recém-nascidos prematuros / Inhalation effects of beclomethasone and furosemide on pulmonary function and oxygenation index of preterm newborns / Efectos de la inhalación de beclometasona y furosemida sobre la función pulmonar e índice de oxigenación de recién nacidos prematuros

O objetivo deste estudo foi avaliar a função pulmonar e o índice de oxigenação de recém-nascidos pré-termo submetidos à inalação endotraqueal de beclometasona e furosemida. Foram avaliados 30 recém-nascidos pré-termo com idade gestacional <36 semanas, sob ventilação mecânica convencional por pelo menos 12 horas. Três inalações sequenciais com as respectivas medicações foram realizadas, com intervalo de três horas entre as mesmas. Foram coletadas amostras de sangue arterial para análise dos gases sanguíneos; após aspiração endotraqueal, a mensuração das variáveis respiratórias foi realizada em dois momentos, antes e após duas horas da última inalação. A complacência dinâmica, assim como o índice de oxigenação, não apresentou diferença estatística significativa entre os momentos antes e após as medicações; no entanto, a resistência de vias aéreas demonstrou redução no grupo beclometasona entre os momentos antes e após a intervenção (p=0,03). Diante desses resultados, não podemos afirmar que a beclometasona e a furosemida inalatória exercem influência significativa na função pulmonar e oxigenação dos recém-nascidos estudados.

The objective of this study was to evaluate lung function and oxygenation index of preterm infants undergoing endotracheal inhaling of beclomethasone and furosemide. We studied 30 newborn preterms with gestational age <36 weeks, undergoing conventional mechanical ventilation for at least 12 hours. Three sequential inhalations with their medications were executed with an interval of three hours between each. We collected samples of arterial blood for gas analysis, and after endotracheal aspiration, the measurement of respiratory variables was performed in two stages, two hours before and after the last inhalation. Dynamic compliance and the oxygenation index showed no statistically significant difference between before and after the medication, however, the airway resistance group demonstrated a reduction in beclomethasone between the moments before and after the intervention (p=0.03). These results cannot imply that inhaled beclomethasone and furosemide exerted significant influence on lung function and oxygenation in the newborn infants studied.

El objetivo de este estudio fue evaluar la función pulmonar e índice de oxigenación de recién nacidos de pre-término sometidos a la inhalación endotraqueal de beclometasona y furosemida. Fueron evaluados 30 recién nacidos de pre-término con edad gestacional <36 semanas, bajo ventilación mecánica convencional por lo menos 12 horas. Tres inhalaciones secuenciales con las respectivas medicaciones fueron realizadas, con intervalo de tres horas entre las mismas. Fueron tomadas muestras de sangre arterial para el análisis de los gases sanguíneos y después de la aspiración endotraqueal, la medición de las vías respiratorias fue realizada en dos momentos, antes y después de dos horas de la última inhalación. La compliance dinámica así como el índice de oxigenación, no presentaron diferencia estadísticamente significativa entre los momentos antes y después de las mediciones, sin embargo, la resistencia de las vías aéreas demostró reducción en el grupo beclometasona entre los momentos antes y después de la intervención (p=0,03). Mediante estos resultados no podemos afirmar que la beclometasona y la furosemida inhalatoria ejercen influencia significativa en la función pulmonar y oxigenación de los recién nacidos estudiados.

Evaluación diurética del producto natural Noni-C (Morinda citrifolia L. ) en un modelo experimental en ratas / Evaluation of the natural product called Noni-C (Morinda citrifolia L. ) as a diuretic in an experimental model using rats

Introducción: en la medicina tradicional de Cuba se usa el fruto de la planta conocida como Noni-C (Morinda citrifolia L.) por su efecto beneficioso sobre la salud. A esta se le atribuyen innumerables propiedades curativas entre las que destacan antihipertensivo, diurético, antitumoral, antiinflamatorio, etc. Sin embargo, no existen estudios preclínicos que demuestren el efecto diurético y validen su uso. Objetivo: evaluar la actividad diurética deL producto natural Noni-C (Morinda citrifolia L.). Métodos: se utilizaron 40 ratas wistar macho, de peso corporal promedio entre 220 y 260 g, repartidas al azar en 5 grupos homogéneos. A los grupos I, II y III se le administró Noni-C a las dosis de 100, 200 y 400 mg/kg de peso corporal respectivamente, el grupo IV fue tratado con furosemida (20 mg/kg), mientras que al grupo V se le inoculó cloruro de sodio 0,9 por ciento. Posteriormente, las ratas se colocaron en jaulas metabólicas individuales para recolectar la orina en 24 h, a la cual se le cuantificó Na+, K+ y Cl- excretados en el volumen final. Resultados: a las 24 h, los volúmenes de orina en las ratas tratadas con el Noni-C a la dosis de 200 y 400 mg/kg fueron de 30,12 y 34,23 mL/24 h, respectivamente; similares a la orina excretada por el grupo que se le administró la furosemida (38,33 mL/24 h) (p< 0,05). Conclusiones: el producto natural Noni-C (Morinda citrifolia L.), mostró actividad diurética a las dosis de 200 y 400 mg/kg por vía oral(AU)

Introduction: in the Cuban traditional herb medicine, the fruit of a plant called Noni-C was used because of its health benefits. A number of curative properties are attributed to this plant, such as antihypertensive, diuretic, antitumoral, antiinflammatory and others. However, there are no preclinical studies that prove the diuretic effect and validate the use of this plant to this end. Objective: to evaluate the diuretic action of Noni-C (Morinda citrifolia L.). Methods: forty Wistar rats weighing 220 to 260 g as average were randomly distributed in 5 homogeneous groups. The groups I, II and III were administered Noni-C at doses of 100, 200 and 400 mg/kg of body weight respectively; group IV was treated with furosemide (20 mg/kg) and group V was inoculated 0.9 percent sodium chloride. The rats were then placed in individual metabolic cages to collect their urine samples for 24 hours and to quantify the amount of excreted Na+, K+ and CI-. Results: after 24 hours, the urine volumes in Noni C-treated rats at doses of 200 and 400 mg/kg were 30.12 abd 34.23 ml/24 h, respectively. These values were similar to those of the group which received furosemide (38.33 mL/24h) (p< 0.05). Conclusions: the natural product called Noni-C showed its diuretic effect at 200 and 400 mg/kg orally administered doses(AU)

Evaluación diurética del producto natural Noni-C (Morinda citrifolia L. ) en un modelo experimental en ratas / Evaluation of the natural product called Noni-C (Morinda citrifolia L. ) as a diuretic in an experimental model using rats

Introducción: en la medicina tradicional de Cuba se usa el fruto de la planta conocida como Noni-C (Morinda citrifolia L.) por su efecto beneficioso sobre la salud. A esta se le atribuyen innumerables propiedades curativas entre las que destacan antihipertensivo, diurético, antitumoral, antiinflamatorio, etc. Sin embargo, no existen estudios preclínicos que demuestren el efecto diurético y validen su uso. Objetivo: evaluar la actividad diurética deL producto natural Noni-C (Morinda citrifolia L.). Métodos: se utilizaron 40 ratas wistar macho, de peso corporal promedio entre 220 y 260 g, repartidas al azar en 5 grupos homogéneos. A los grupos I, II y III se le administró Noni-C a las dosis de 100, 200 y 400 mg/kg de peso corporal respectivamente, el grupo IV fue tratado con furosemida (20 mg/kg), mientras que al grupo V se le inoculó cloruro de sodio 0,9 por ciento. Posteriormente, las ratas se colocaron en jaulas metabólicas individuales para recolectar la orina en 24 h, a la cual se le cuantificó Na+, K+ y Cl- excretados en el volumen final. Resultados: a las 24 h, los volúmenes de orina en las ratas tratadas con el Noni-C a la dosis de 200 y 400 mg/kg fueron de 30,12 y 34,23 mL/24 h, respectivamente; similares a la orina excretada por el grupo que se le administró la furosemida (38,33 mL/24 h) (p< 0,05). Conclusiones: el producto natural Noni-C (Morinda citrifolia L.), mostró actividad diurética a las dosis de 200 y 400 mg/kg por vía oral

Introduction: in the Cuban traditional herb medicine, the fruit of a plant called Noni-C was used because of its health benefits. A number of curative properties are attributed to this plant, such as antihypertensive, diuretic, antitumoral, antiinflammatory and others. However, there are no preclinical studies that prove the diuretic effect and validate the use of this plant to this end. Objective: to evaluate the diuretic action of Noni-C (Morinda citrifolia L.). Methods: forty Wistar rats weighing 220 to 260 g as average were randomly distributed in 5 homogeneous groups. The groups I, II and III were administered Noni-C at doses of 100, 200 and 400 mg/kg of body weight respectively; group IV was treated with furosemide (20 mg/kg) and group V was inoculated 0.9 percent sodium chloride. The rats were then placed in individual metabolic cages to collect their urine samples for 24 hours and to quantify the amount of excreted Na+, K+ and CI-. Results: after 24 hours, the urine volumes in Noni C-treated rats at doses of 200 and 400 mg/kg were 30.12 abd 34.23 ml/24 h, respectively. These values were similar to those of the group which received furosemide (38.33 mL/24h) (p< 0.05). Conclusions: the natural product called Noni-C showed its diuretic effect at 200 and 400 mg/kg orally administered doses

Efeito da associação de furosemida e fenilbutazona sobre variáveis hidroeletrolíticas de cavalos antes e após a corrida / The effect of furosemide and phenylbutazone association on the fluid and electrolyte characteristics of horses before and after a race

Verificaram-se os efeitos da associação de furosemida e fenilbutazona sobre variáveis hidroeletrolíticas de cavalos antes e após a corrida. Dezenove equinos foram distribuídos em três grupos, de acordo com os protocolos de tratamento. O primeiro grupo, de cinco animais, não recebeu medicação (grupo-controle); o segundo grupo, de sete animais, foi tratado com furosemida, na dose de 1mg/kg, por via intramuscular, até quatro horas antes do páreo; o terceiro, de sete animais, recebeu furosemida, por via intramuscular, e fenilbutazona, por via intravenosa, nas doses de 1,0 e 4,4mg/kg, respectivamente, até quatro horas antes da corrida. Amostras de sangue foram colhidas antes, imediatamente após e duas horas após o páreo, para avaliação da osmolalidade plasmática e das concentrações plasmáticas de sódio, potássio e cloreto. A utilização de furosemida e da associação furosemida e fenilbutazona até 4h antes dos páreos nas dosagens descritas alterou (P<0,05) a osmolalidade plasmática dos equinos, mas não alterou (P>0,05) as concentrações de sódio, potássio e cloreto. Os páreos alteraram de forma fisiológica a osmolalidade plasmática e a concentração sanguínea de K+ devido ao exercício de alta intensidade.

The objective of this study was to verify the effects of furosemide and phenylbutazone association on fluid and electrolyte balance characteristics of horses before and after a race. Nineteen horses were divided into three groups according to treatment protocols. The first group (five animals - control) was not medicated. A second group (seven animals) was treated with furosemide (1mg/kg, intramuscular up to four hours before the race). A third group (seven animals) received furosemide (1mg/kg) and phenylbutazone (4.4mg/kg), both intramuscular, up to four hours before race. Blood samples were collected before, immediately after and two hours after a race to evaluate the plasma osmolality and sodium, potassium and chloride concentrations. The use of furosemide and furosemide plus phenylbutazone up to four hours before the race altered (P<0.05) the plasma osmolality but did not change (P>0.05) the sodium, potassium and chloride concentrations. It was not possible to determine an antagonist effect of phenylbutazone on furosemide, based on fluid and electrolyte balance. Due to the high intensity exercise, the increase in plasma osmolality and potassium concentration was attributed to the race effect.

Efecto diurético de la tintura al 50 por ciento de Varronia globosa Jacq (yerba de la sangre) en ratas / Diuretic activity of 50 percent tinction from Varronia globosa Jacq (yerba de la sangre) in rats

Introducción: en la medicina tradicional de Cuba se usa la decocción de las hojas frescas de la planta conocida como yerba de la sangre (Varronia globosa Jacq) por sus efectos beneficiosos sobre las afecciones renales y como antihipertensivo; sin embargo, no existen estudios preclínicos que demuestren este efecto y validen su uso. Objetivo: determinar la actividad diurética de la tintura al 50 por ciento de las hojas y ramas de V globosa. Métodos: se utilizaron 40 ratas machos de la línea isogénica Wistar, de peso corporal promedio de 260 g, asignadas a 4 grupos de trabajo (n= 10) de forma aleatoria. Los resultados fueron comparados con furosemida 20 mg/kg de peso y con cloruro de sodio al 0,9 por ciento utilizado como control negativo. Los grupos experimentales fueron tratados con tintura al 50 por ciento, preparada de las hojas y ramas de V globosa en dosis de 25 y 50 mg/kg. La excreción urinaria se midió a las 24 h y se midió la concentración de cloro, sodio y potasio. Resultados: a las 24 h, los volúmenes acumulados de orina en los grupos que recibieron tintura de V. globosa a dosis de 50 mg/kg, tuvieron un comportamiento similar al grupo control positivo (furosemida) y resultaron significativamente diferentes del control negativo (cloruro de sodio 0,9 por ciento). La tintura de V globosa demostró tener efecto natriurético a la dosis de 50 mg/kg. Conclusiones: la tintura al 50 por ciento de V. globosa, conocida tradicionalmente como yerba de la sangre, mostró actividad diurética a dosis de 50 mg/kg por vía oral

Introduction: decoction of fresh leaves from a well-known plant called yerba de la sangre (Varronia globosa Jacq.) is used in Cuba due to its beneficial effects for treating renal and hypertensive disorders; however, there is no preclinical study to prove this action and to validate its use. Objective: to determine the diuretic activity of 50 percent tincture from leaves and branches of V globosa. Methods: forty Wistar male rats weighing 260 g each as average were randomly assigned to 4 working groups (n= 10). The results were compared to those of furosemide at a dose of 20 mg/kg, and of 0,9 percent sodium chloride as negative control. The experimental groups received 50 percent tincture from leaves and branches of V globosa at doses of 25 and 50 mg/kg. The urinary excretion was measured at 24 hours; additionally, chloride, sodium and potassium concentrations were considered. Results: after 24 hours, the urine volumes in the groups that received tinction from V globosa at a dose of 50 mg/kg behaved similarly to the positive control group (furosemide) and significantly different from the negative control group (0.9 percent sodium chloride). V globosa tincture proved to have natriuretic effect at 50 mg/kg dose. Conclusions: 50 percent tincture from V. globosa, traditionally known as yerba de la sangre, showed diuretic action at 50 mg/kg orally administered dose

Efecto diurético de la tintura al 50 por ciento de Varronia globosa Jacq (yerba de la sangre) en ratas / Diuretic activity of 50 percent tinction from Varronia globosa Jacq (yerba de la sangre) in rats

Introducción: en la medicina tradicional de Cuba se usa la decocción de las hojas frescas de la planta conocida como yerba de la sangre (Varronia globosa Jacq) por sus efectos beneficiosos sobre las afecciones renales y como antihipertensivo; sin embargo, no existen estudios preclínicos que demuestren este efecto y validen su uso. Objetivo: determinar la actividad diurética de la tintura al 50 por ciento de las hojas y ramas de V globosa. Métodos: se utilizaron 40 ratas machos de la línea isogénica Wistar, de peso corporal promedio de 260 g, asignadas a 4 grupos de trabajo (n= 10) de forma aleatoria. Los resultados fueron comparados con furosemida 20 mg/kg de peso y con cloruro de sodio al 0,9 por ciento utilizado como control negativo. Los grupos experimentales fueron tratados con tintura al 50 por ciento, preparada de las hojas y ramas de V globosa en dosis de 25 y 50 mg/kg. La excreción urinaria se midió a las 24 h y se midió la concentración de cloro, sodio y potasio. Resultados: a las 24 h, los volúmenes acumulados de orina en los grupos que recibieron tintura de V. globosa a dosis de 50 mg/kg, tuvieron un comportamiento similar al grupo control positivo (furosemida) y resultaron significativamente diferentes del control negativo (cloruro de sodio 0,9 por ciento). La tintura de V globosa demostró tener efecto natriurético a la dosis de 50 mg/kg. Conclusiones: la tintura al 50 por ciento de V. globosa, conocida tradicionalmente como yerba de la sangre, mostró actividad diurética a dosis de 50 mg/kg por vía oral(AU)

Introduction: decoction of fresh leaves from a well-known plant called yerba de la sangre (Varronia globosa Jacq.) is used in Cuba due to its beneficial effects for treating renal and hypertensive disorders; however, there is no preclinical study to prove this action and to validate its use. Objective: to determine the diuretic activity of 50 percent tincture from leaves and branches of V globosa. Methods: forty Wistar male rats weighing 260 g each as average were randomly assigned to 4 working groups (n= 10). The results were compared to those of furosemide at a dose of 20 mg/kg, and of 0,9 percent sodium chloride as negative control. The experimental groups received 50 percent tincture from leaves and branches of V globosa at doses of 25 and 50 mg/kg. The urinary excretion was measured at 24 hours; additionally, chloride, sodium and potassium concentrations were considered. Results: after 24 hours, the urine volumes in the groups that received tinction from V globosa at a dose of 50 mg/kg behaved similarly to the positive control group (furosemide) and significantly different from the negative control group (0.9 percent sodium chloride). V globosa tincture proved to have natriuretic effect at 50 mg/kg dose. Conclusions: 50 percent tincture from V. globosa, traditionally known as yerba de la sangre, showed diuretic action at 50 mg/kg orally administered dose(AU)

Actividad diurética de una decocción de Costus pictus D Don / Diuretic activity from a Costus pictus D Don decoction

INTRODUCCIÓN: Costus pictus D Don (caña mexicana) es una especie cultivada como ornamental en Cuba y la decocción de sus hojas se emplea tradicionalmente para afecciones urinarias como infecciones, litiasis y cólicos renales. OBJETIVO: evaluar la actividad diurética de la decocción de hojas de C. pictus. MÉTODOS: se elaboró una decocción con hojas secas al 30 por ciento y se administró a ratas machos Wistar a dosis de 200, 400 y 800 mg de sólidos totales/kg. El volumen fue completado con solución salina fisiológica para lograr una sobrecarga hidrosalina con un volumen total de administración constante de 40 mL/kg, tanto para los grupos tratados como para el control positivo (furosemida, 20 mg/kg) y control negativo (cloruro de sodio, 0,9 por ciento). Se midieron los volúmenes de orina excretados a ½, 1, 2, 3, 4, 5 y 6 h y se determinaron las concentraciones de electrolitos (Na+ y K+) en la orina total colectada. RESULTADOS: se observó acción diurética dependiente de la dosis en la decocción del C. pictus con mejores resultados a dosis de 800 mg/kg. Los niveles de sodio y potasio eliminados en orina fueron significativamente mayores a los del grupo control negativo, lo que nos hace pensar en un comportamiento similar a la furosemida, a pesar de que nunca se llega a superar su efecto. La actividad diurética fue mayor en el último nivel de dosis (800 mg/kg). CONCLUSIONES: los resultados obtenidos permiten concluir que la decocción al 30 por ciento de hojas secas de C. pictus presentó efecto diurético dosis dependiente

INTRODUCTION: Costus pictus D Don (Mexican cane) is a species cultivated as ornamental in Cuba and decoction of leaves is traditionally used for urinary affections including infections, lithiasis and renal colitis. OBJECTIVE: to assess the diuretic activity from the C pictus leaves decoction. METHODS: a decoction with 30 percent dry leaves was made and given to Wistar male rats at 200, 400 and 800 mg doses of total solids/kg. Volume was completed with saline solution to achieve a hydrosaline overload with a total volume of constant administration of 40 mL/kg for treatment group and for the positive control (20 mg/kg Furosemide) and the negative control (0,9 percent sodium chloride ). Urine volume released were measured at half an hour, 1, 2, 3, 4, 5 and 6 hours and electrolytes concentrations (Na+ and K+) were assessed in total collected urine. RESULTS: there was a diuretic action depending on dose in C. pictus decoction with better results using the 800 mg/kg dose. The sodium and potassium levels released in urine were higher than those of negative control group thus, we think about a similar behavior to Furosemide, despite its effect never is surmountable. The diuretic activity was higher in the last dose level (800 mg/kg). CONCLUSIONS: results achieved allow us to conclude that the 30 percent decoction of dry leaves of C pictus had a dose-dependent diuretic effect