Efeitos do propofol administrado por via intracelomática em cágados-de-barbicha (Phrynops geoffroanus) Schweigger, 1812 / Effects of propofol administered by intracelomatic route in Geoffroy's toadhead turtle (Phrynops geoffroanus) Schweigger, 1812

O presente estudo avaliou a influência do regime hídrico sobre efeitos do propofol em Phrynops geoffroanus, bem como a qualidade da contenção farmacológica produzida. Foram utilizados 10 animais, anestesiados em dois momentos com propofol, na dose de 35mg/kg, por via intracelomática, com intervalo de 15 dias. O grupo 1 fora retirado da água 12 horas antes do procedimento e o grupo 2 permaneceu dentro da água até o momento da indução anestésica. Foram mensuradas frequência cardíaca, pressão arterial sistólica, temperatura, frequência respiratória e saturação de oxi-hemoglobina, e avaliados duração do período de latência, período hábil, período de recuperação e qualidade da contenção farmacológica. Houve diferença significativa entre grupos apenas quanto à frequência cardíaca. No grupo 1, as médias dos períodos de latência, hábil anestésico e de recuperação foram de 16,8±8,4, 86,5±79,4 e 1,5±3,8 minutos, respectivamente. Já no grupo 2, as médias foram de 19,9±9,8, 110,9±104,7 e 28,8±58,2 minutos, respectivamente. Concluiu-se que o regime hídrico de 12 horas não influenciou os parâmetros anestésicos e fisiológicos dos animais e que a qualidade da contenção farmacológica foi considerada boa em ambos os grupos.(AU)

The present study evaluated the influence of the water regime on the effects of propofol on Phrynops geoffroanus, as well as the quality of the pharmacological containment produced. Ten animals, anesthetized at two times with propofol at a dose of 35mg / kg, were used intracelomatically with a 15 day interval. Group 1 was withdrawn from the water 12 hours prior to the procedure and Group 2 remained in the water until the time of anesthetic induction. Heart rate, systolic blood pressure, temperature, respiratory rate and oxyhemoglobin saturation were measured and the duration of the latency period, skill period, recovery period and quality of pharmacological containment were measured. There was a significant difference between groups only regarding heart rate. In Group 1, the means of the latency, skillful anesthesia and recovery periods were 16.8±8.4, 86.5±79.4 and 1.5±3.8 minutes, respectively. In Group 2, the mean values were 19.9±9.8, 110.9±104.7 and 28.8±58.2 minutes, respectively. It was concluded that the 12-hour water regime did not influence the anesthetic and physiological parameters of the animals, and the quality of the pharmacological restraint was considered good in both groups.(AU)

Nutrición parenteral en neonatos: individualización de la prescripción / Parenteral nutrition in neonates: Individualization of the prescription

Introducción: El parto prematuro suprime radicalmente la energía fácilmente asimilable que proporciona el transporte placentario, planteando una emergencia médica nutricional, ya que el aparato digestivo del recién nacido pretérmino es incapaz de manejar y absorber la energía que requiere la vida extrauterina y el crecimiento posnatal. Por sus características de inmadurez y la morbilidad propia del recién nacido pretérmino y/o pequeño para su edad gestacional, es necesario individualizar la composición de la nutrición parenteral, adaptándola a las necesidades y a la tolerancia de cada neonato. Objetivo: El objetivo de nuestro trabajo es diseñar un programa que permita el cálculo de la nutrición parenteral del recién nacido de forma individualizada. Métodos: Se revisan las recomendaciones actuales de macro/micronutrientes, y con las variables edad gestacional, peso, días de vida y parámetros analíticos se establecen unas ecuaciones matemáticas. Resultados: Se obtiene una serie de funciones continuas que relacionan los requerimientos basados en la evidencia científica ac-tual con la edad, el peso y el día de la nutrición, simplificando la prescripción individualizada y la elaboración de la nutrición parenteral. Conclusiones: Este método de cálculo permite disminuir los errores en la estimación de la nutrición parenteral en recién nacidos pretérmino, ya que, al simplificar las operaciones, el riesgo de error disminuye, lo que permite realizar el cálculo de una nutrición parenteral individualizada de forma sencilla, rápida y segura (AU)

Introduction: Preterm birth suppresses radically easily assimilable energy that provides placental transport, posing a nutritional medical emergency, because the digestive tract of preterm infant is unable to manage and absorb the energy required by extrauterine life and postnatal growth. Because of the characteristics of immaturity and own morbidity of newborn preterm and/or small for gestational age, it’s necessary to individualize the composition of parenteral nutrition, adapting it to the needs and tolerance of each newborn. Objective: The aim of our work is to design a program that allows the calculations of parenteral nutrition of the newborn individually. Methods: Current recommendations of macro and micronutrients are reviewed, and with the variables gestational age, weight, days of life and laboratory parameters, some mathematical equations are established. Results: We obtain a series of continuous functions relating requirements based on current scientific evidence with age, weight and nutrition day, simplifying the individualized prescription and the development of parenteral nutrition. Conclusions: This calculation method allow us to reduce errors in the calculation of parenteral nutrition in preterm infants, because simplifying operations the risk of error decreases, allowing the calculation of an individual parenteral nutrition easily, quickly and safely (AU)

Impact of comorbidities in pulmonary rehabilitation outcomes in patients with chronic obstructive pulmonary disease.

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) represents an increasing burden worldwide. COPD can no longer be considered a disease which only involves the lungs, its systemic consequences make it an important risk factor for other chronic comorbidities. AIM: To determine the frequency of comorbidities in patients with COPD undergoing a pulmonary rehabilitation program (PRP) and to evaluate the influence of baseline characteristics as well as comorbidities on the outcomes of PRP. METHODS: The present study included all COPD patients that were admitted to a PRP in our unit. The response to PR was measured by the improvement in exercise tolerance (6 minute walk test), dyspnea (Mahler's Dyspnea Index) and health status (St. George's Respiratory Questionnaire). RESULTS: 114 patients with COPD were included. Most patients (96,5%) had at least one comorbidity. Metabolic diseases (71.1%), cardiovascular diseases (67.5%), other respiratory conditions (57.9%) and anxiety/depression (21.1%) were the most prevalent ones. 64.9%, 64.9% and 51.1% of the patients improved in terms of exercise tolerance, quality of life and dyspnea, respectively. The overall results were similar in all levels of the disease and in all comorbid subgroups. Logistic regression analysis showed that respiratory failure and ischemic heart disease negatively influenced improvement in health status and anxiety/depression predicted lower improvement in dyspnea. CONCLUSION: PR was associated with improvements in all comorbid subgroups of patients, underlining the important role of exercise training in rehabilitation of those chronic diseases associated with COPD. On the other hand, the presence of comorbidities in COPD patients, if clinically controlled, should not preclude access to PR.

Nutrición parenteral domiciliaria en paciente con enfermedad de Crohn; a propósito de un caso / Home parenteral nutrition in Crohn's disease patient; a case report

Paciente diagnosticada de Enfermedad de Crohn con patrón inflamatorio que evoluciona a estenosante-perforante, provocando una perforación abdominal con peritonitis fecaloidea. Es sometida a tres intervenciones quirúrgicas, derivando en numerosas complicaciones y una evolución clínica tórpida. Dado el estado de desnutrición al ingreso se le prescribe Nutrición Parenteral Total (NPT), prolongándose la administración durante más de 10 meses. En este periodo se le suspende durante 5 días, pero la persistencia de una fístula enterocutánea provoca la restauración de la NPT. Tras su estabilización clínica, la paciente es dada de alta hasta recuperación de su estado nutricional necesario para realizar una cirugía de reconstrucción del intestino, continuando con NPT en su domicilio. Después de 7 meses y medio, la paciente con un estado nutricional óptimo, es sometida a la intervención quirúrgica, evolucionando favorablemente y suspendiendo la NPT a los 9 días (AU)

Patient diagnosed with Crohn's Disease with inflammatory pattern that evolves stenosing-piercing, causing abdominal perforation and fecal peritonitis. She was underwent to three surgeries, leading to numerous complications and a torpid clinical course. Given the state of malnutrition on admission it was prescribed Total Parenteral Nutrition (TPN), extending the administration for more than 10 months. In this period the TPN is suspended for 5 days, but the persistence of an enterocutaneous fistula causes the restoration of the TPN. After clinical stabilization, the patient is discharged to recover her nutritional status necessary to perform a bowel reconstruction surgery, continuing with TPN at home. After 7 and a half months, the patient with an optimal nutritional status, undergoes surgery, evolving favorably and suspending the TPN at 9 days (AU)

Mandibular implant-supported removable partial denture with distal extension: a systematic review.

The aim of this article is to investigate patient satisfaction, survival rate of implants, and prosthetic complications or maintenance for rehabilitation with removable partial dentures associated with implants in mandibular Kennedy class I and II cases. A systematic literature review was conducted by three independent reviewers including articles published from January 1981 through September 2011. Medline and Cochrane Library electronic databases were used in addition to hand searching to assess clinical outcomes for mandibular implant-supported removable partial denture with distal extension. This review yielded 1751 records that were narrowed down to 5. The studies revealed implant survival rates ranging from 95% to 100% with one failure reported of 98 implants. The removable partial dentures associated with implant in mandibular free-end arches showed some complications and need of repair for relining, pitting of the healing abutment, replacement of resilient component of the attachment, damage in framework, screw loosening and damage in acrylic denture base. Patient satisfaction was evaluated through a five-point questionnaire, and results ranged between 4.12 and 5.0, considering 1 as the least favourable situation. The literature review showed increase in patient satisfaction and high survival rates of implants associated with mandibular removable partial dentures with distal extensions. However, some complications and need of prosthetic repair were reported. Although this treatment approach could represent a low-cost and beneficial rehabilitation for free-end mandibular ridges, the lack of controlled and randomised well-designed clinical trials suggests further studies with more representative samples to validate the outcomes of this treatment modality.

Amlodipine in pediatric patient with uncontrolled multifactorial hypertension. Formulation of amlodipine oral suspension.

OBJECTIVE: To describe the case of treatment with amlodipine in a poorly controlled hypertension in a pediatric patient diagnosed with tricodistrofia. CASE SUMMARY: Girl 5 years old, diagnosed of tricodistrofia included within the Tay-Sachs syndrome. As a consequence of a cardiac arrest suffered in the context of a respiratory distress syndrome associated with infection by influenza A, she developed hypertension initially treated with nifedipine and captopril. After several months of treatment and a poor control of the hypertension, a change of treatment was decided, substituting nifedipine by amlodipine (2.5 mg/24 hours orally) and captopril by enalapril (2.5 mg/24 hours orally). Pharmacy service is request to get a amlodipine syrup that allows a dose adjustment to the needs of the patient. After the change of treatment the patient begins to maintain diastolic blood pressure levels within the normal range, suspending the administration of enalapril, maintaining good control of blood pressure with amlodipine 2 mg/24 hours. DISCUSSION: Most of antihypertensive drugs used in adults do not have clinical trials to evaluate its effects in the pediatric population. Furthermore, the lack of familiarity with the pharmacokinetic characteristics of the child, raises problems to adjust the dose to the changing reality of a child. In this situation, clinical experience supports the use of some of these drugs in children with optimal results. With the addition to the pediatric field of calcium antagonists and ACE-inhibitors or ARB-II, they allow as to have greater potential therapeutic alternatives.

[Home parenteral nutrition in Crohn's Disease patient: a case report]. / Nutrición parenteral domiciliaria en paciente con enfermedad de Crohn: a propósito de un caso.

Patient diagnosed with Crohn's Disease with inflammatory pattern that evolves stenosing-piercing, causing abdominal perforation and fecal peritonitis. She was underwent to three surgeries, leading to numerous complications and a torpid clinical course. Given the state of malnutrition on admission it was prescribed Total Parenteral Nutrition (TPN), extending the administration for more than 10 months. In this period the TPN is suspended for 5 days, but the persistence of an enterocutaneous fistula causes the restoration of the TPN. After clinical stabilization, the patient is discharged to recover her nutritional status necessary to perform a bowel reconstruction surgery, continuing with TPN at home. After 7 and a half months, the patient with an optimal nutritional status, undergoes surgery, evolving favorably and suspending the TPN at 9 days.

Dynamic functional impression technique for severely resorbed alveolar ridges.

The process of bone resorption can reduce the volume of the alveolar crest, which makes may make difficult impression taking of the alveolar tissue and the subsequent fit of a new denture. This clinical report describes a fast and simple technique for impressions of edentulous ridges to replace complete dentures, using a temporary tissue conditioner material on the denture base. The existing denture must cover the whole supporting area and should be in harmony with the adjacent oral structures. This technique reduces the number of steps involved and minimizes treatment time and expenses.

A clinical follow-up study of the periodontal conditions of RPD abutment and non-abutment teeth.

The purpose of this study was to evaluate the periodontal conditions of removable partial denture (RPD) wearers, comparing direct and indirect abutment teeth, and the teeth not involved in the denture design before denture placement and 1 year later. Fifty patients (32 women and 18 men), average age 45, were assessed by the same examiner at the moment of denture insertion and 3, 6, 9 and 12 months later. The following items were verified in each assessment: probing depth (PD), plaque index (PI) and gingival index (GI). PD and PI data were evaluated by anova test for linear trend followed by Tukey-Kramer post-test, while GI data were analysed by Friedman's test. Results showed that the teeth not involved in the denture design were the least affected for all variables studied. It was also verified that PD and GI mean values increased from the initial assessment to 1 year of RPD wearing in every group, but that only PI showed a significant increase. This study indicated that direct and indirect retainer elements tend to undergo more damaging periodontal effects associated with RPD wearing when compared with non-abutment elements. Plaque index values were significantly higher after 1 year of denture use.

Proteína C-reactiva ultrasensible en pacientes con y sin periodontitis crónica severa generalizada / Ultra-sensible C-reactive protein in patients with and without chronic severe generalized periodontitis

Introducción: La proteína C-reactiva ultrasensible (PCR-US) constituye un mediador inflamatorio utilizado como predictor del riesgo cardiovascular que viene siendo investigado como factor indicativo de la relación entre enfermedades cardiovasculares y periodontales. Este trabajo tuvo como objetivo comparar los niveles séricos de proteína C-reactiva entre pacientes con y sin periodontitis crónica severa generalizada. Material y métodos: Se realizó un estudio seccional, utilizando una muestra de 60 pacientes, siendo29 participantes con enfermedad periodontal (Grupo I) y 31 sin enfermedad (Grupo II). Como criterios de inclusión fueron seleccionados pacientes con diagnóstico de periodontitis crónica severa generalizada. La investigación constó de dos etapas, clínica y bioquímica. La clínica consistió en el examen periodontal y la bioquímica en la recogida de sangre para determinación de los niveles de PCR-US y un hemograma. Resultados: El grupo con enfermedad periodontal presentó una media de 0,36 mg/dl, mientras el sin enfermedad de 0,17 mg/dl (p=0,061). El riesgo cardiovascular para el grupo I fue clasificado como alto para 27,6% de los participantes y bajo para 72,4%. En el grupo II, 6,45% presentaban alto riesgo y 93,5% bajo riesgo, siendo esa relación estadísticamente significativa obtenida por el test de Fisher (p=0,042), presentando uno OR=5,33; IC95% (1,02-27,4). Las variables interventores investigadas no presentaron asociación estadísticamente significativa con los niveles de PCR-US. Conclusión: EL estudio indicó que pacientes portadores de periodontitis crónica severa generalizada no presentaron niveles séricos de PCR-US estadísticamente diferente de los pacientes sin enfermedad. La periodontitis actuó como factor asociado para la elevación de los niveles de la PCR-US, aunque con frágil asociación (AU)

Introduction: The high sensitivity C-reactive protein (hsCRP) constitutes an inflammatory mediator used as predictor of cardiovascular risk that comes being researched as indicative relation factor between cardiovascular and periodontal diseases. This work had the purpose of compare sericlevels of C-reactive protein between patients with and without chronic severe generalized periodontitis. Material and methods: A cross-sectional study was realized using a sample with 60 patients, being29 participants carriers of periodontal diseases (Group I) and 31 without periodontal diseases (Group II). As inclusion criteria were selected patients with diagnosis of chronic severe generalized periodontitis. The research consisted of two stages, clinc and biochemical. The stage was constituted of periodontal examination and the biochemist stage, of the blood collection for determination hsCRP levels and a hemogram. Results: Periodontal disease group presented a average of 0,36 mg/dL, while the group without disease presented 0,17 mg/Dl (p = 0,061). The cardiovascular risk for the group I was classified high for 27,6% of participants and low for 72,4% of them. In the group II, 6,45% presented high riske 93,5% low risk, being this relation significant statistically gotten for Fisher’s Test (p = 0,042)presenting OR = 5,33; IC = 95% (1,02–27,4). The independents variables researched do not presented significant statistically association with the levels of hsCRP. Conclusion: The study indicated that despite of carriers patients of periodontal diseases do not present differents seric levels of hsCRP from the other group, the periodontal disease was considered as risk factor for hsCRP levels elevation (AU)

Proteína C-reactiva ultrasensible en pacientes con y sinperiodontitis crónica severa generalizada / Ultra-sensible C-reactive protein in patients with and without chronic severe generalized periodontitis

Introducción: La proteína C-reactiva ultrasensible (PCR-US) constituye un mediador inflamatorio utilizado como predictor del riesgo cardiovascular que viene siendo investigado como factor indicativo de la relación entre enfermedades cardiovasculares y periodontales. Este trabajo tuvo como objetivo comparar los niveles séricos de proteína C-reactiva entre pacientes con y sin periodontitiscrónica severa generalizada. Material y métodos: Se realizó un estudio seccional, utilizando una muestra de 60 pacientes, siendo29 participantes con enfermedad periodontal (Grupo I) y 31 sin enfermedad (Grupo II). Como criterios de inclusión fueron seleccionados pacientes con diagnóstico de periodontitis crónica severa generalizada. La investigación constó de dos etapas, clínica y bioquímica. La clínica consistió en el examen periodontal y la bioquímica en la recogida de sangre para determinación de los niveles de PCR-US y un hemograma. Resultados: El grupo con enfermedad periodontal presentó una media de 0,36 mg/dl, mientras el sin enfermedad de 0,17 mg/dl (p=0,061). El riesgo cardiovascular para el grupo I fue clasificado como alto para 27,6% de los participantes y bajo para 72,4%. En el grupo II, 6,45% presentaban alto riesgo y 93,5% bajo riesgo, siendo esa relación estadísticamente significativa obtenida por el test de Fisher (p=0,042), presentando uno OR=5,33; IC95% (1,02-27,4). Las variables interventores investigadas no presentaron asociación estadísticamente significativa con los niveles de PCR-US. Conclusión: EL estudio indicó que pacientes portadores de periodontitis crónica severa generalizada no presentaron niveles séricos de PCR-US estadísticamente diferente de los pacientes sin enfermedad. La periodontitis actuó como factor asociado para la elevación de los niveles de la PCR-US, aunque con frágil asociación (AU)

Introduction: The high sensitivity C-reactive protein (hsCRP) constitutes an inflammatory mediator used as predictor of cardiovascular risk that comes being researched as indicative relation factor between cardiovascular and periodontal diseases. This work had the purpose of compare sericlevels of C-reactive protein between patients with and without chronic severe generalized periodontitis. Material and methods: A cross-sectional study was realized using a sample with 60 patients, being29 participants carriers of periodontal diseases (Group I) and 31 without periodontal diseases (Group II). As inclusion criteria were selected patients with diagnosis of chronic severe generalized periodontitis. The research consisted of two stages, clinc and biochemical. The stage was constituted of periodontal examination and the biochemist stage, of the blood collection for determination hsCRP levels and a hemogram. Results: Periodontal disease group presented a average of 0,36 mg/dL, while the group without disease presented 0,17 mg/Dl (p = 0,061). The cardiovascular risk for the group I was classified high for 27,6% of participants and low for 72,4% of them. In the group II, 6,45% presented high riske 93,5% low risk, being this relation significant statistically gotten for Fisher’s Test (p = 0,042)presenting OR = 5,33; IC = 95% (1,02–27,4). The independents variables researched do not presented significant statistically association with the levels of hsCRP. Conclusion: The study indicated that despite of carriers patients of periodontal diseases do not present differents seric levels of hsCRP from the other group, the periodontal disease was considered as risk factor for hsCRP levels elevation (AU)

Hardness and compressive strength of indirect composite resins: effects of immersion in distilled water.

The aim of this study was to evaluate the effect of ageing in distilled water on the hardness and compressive strength of a direct composite resin Z100, a feldspatic porcelain (Noritake) and three indirect composites (Artglass, Solidex and Targis). For the Vickers hardness tests, five disk-shaped specimens (2 x 4 mm) of each material were prepared according to the manufacturers' instructions. The hardness tests were conducted using a Vickers diamond indentor. Compressive strength measurements were recorded on cylindrical specimens with a diameter of 6 mm and a length of 12 mm. The compression tests were carried out with a constant cross-head speed of 0.5 mm min(-1) on a mechanical test machine. For each material, 10 specimens were tested after 7 days of dry storage at 37 +/- 1 degrees C and 10 specimens were tested after water storage at 37 +/- 1 degrees C for 180 days. Noritake porcelain specimens showed higher hardness values than the composites. Among the composite materials, Z100 promoted the highest VHN values, regardless of the ageing periods. The results showed that Solidex and Z100 had the highest compressive strength values. Ageing in water reduced the hardness for all composites, but had no long-term effect on the compressive strength.

Solution-phase combinatorial synthesis and evaluation of piperazine-2,5-dione derivatives.

An efficient one-pot synthesis of a 61-membered combinatorial chemistry library of piperazine-2,5-diones was accomplished. Results of combinatorial synthesis, purification, analysis, and biological evaluation are described.

[The TPN of newborn infants: the rationalization of the calculations and of the prescription]. / NPT de neonatos: racionalización de los cálculos y de la presecripción.

We try to simplify the calculus of TPN necessities in newborns adjusting the most common bibliography tabulated values to mathematical equations. Values are transformed into factors: Fn (g of N/Kg of weight), Fk (no protein Kcal/g of N), Fg (glucose Kcal/total Kcal) and Fv (volume/total Kcal) that can be correlated with the analytical state of patient, weight and nutrition day. Once the functions were established we automated calculations using a spreadsheet program that simplifies and make easier the TPN elaboration.