Practical approach to referral from primary health care to a cardiology hospital consultation in 2022.

In Portugal, up to 38% of the population has cardiovascular disease, which highlights the importance of primary health care (PHC) in its management. Adequate management of people with cardiovascular disease often requires hospital referral for a cardiology consultation. However, it is not always easy to ascertain which situations should be referred, especially given that PHC does not have access to all diagnostic exams recommended by international guidelines, such as natriuretic peptides in heart failure or computed tomography coronary angiogram in chronic coronary syndromes, among others. The aim of this document is to describe a practical approach to the most frequent heart diseases that may require a referral for a hospital cardiology consultation. Thus, in the different chapters, the recommendations for referral are highlighted generically according to group of disease, as well as, albeit briefly, the initial clinical approach within the scope of PHC for a differential diagnosis and more efficient follow-up. A modified Metaplan methodology was used. A panel of 4 cardiology specialists and 3 specialists in General and Family Medicine developed this document, which should not be taken as an official guideline, but as additional guidance for the correct referral of patients. It is therefore advisable to validate these recommendations locally with the referral hospital, as well as to be aware of the respective international and national guidelines.

Riparin B, a Synthetic Compound Analogue of Riparin, Inhibits the Systemic Inflammatory Response and Oxidative Stress in Mice.

The aim of our study was to evaluate the anti-inflammatory, anti-nociceptive, and anti-oxidant action of Riparin B in vivo. We performed experiments in which we induced paw edema by carrageenan and other mediators, carrageenan-induced peritonitis and the level of myeloperoxidase (MPO) activity, pro-inflammatory cytokines (TNF-α and IL-1ß), malondialdehyde (MDA) acid, and glutathione (GSH) from the peritoneal fluid. We also performed behavior tests such as acetic acid-induced writhing, formalin-induced linking, and the hot plate test. Among the doses tested of the Riparin B (1, 3, and 10 mg/kg), the dose of 10 mg/kg showed the strongest effect, and this dose was able to reduce the paw edema induced by carrageenan, dextran, histamine serotonin, bradykinin, 48/80, and PGE2. Similarly, the Riparin B in the same dose reduced cell migration and significantly decreased the nociception induced by formalin and acetic acid and reversed the parameters of the oxidative stress. Thus, we can infer that Riparin B exhibits anti-inflammatory, anti-nociceptive, and anti-oxidant actions in vivo.

Laticifer proteins from Plumeria pudica inhibit the inflammatory and nociceptive responses by decreasing the action of inflammatory mediators and pro-inflammatory cytokines

AbstractSome publications have described the pharmacological properties of latices proteins. Thus, in the present study proteins from Plumeria pudica Jacq., Apocynaceae, latex were evaluated for anti-inflammatory and antinociceptive activities. Obtained data showed that an intraperitoneal administration of different doses of latex was able to reduce the paw edema induced by carrageenan in a dose-dependent manner (better dose 40 mg/kg; 72.7% inhibition at 3rd and 78.7% at 4th hour) and the edema induced by dextran (40 mg/kg; 51.5% inhibition at 30 min and 93.0% at 1st hour). Inhibition of edema induced by carrageenan was accompanied by a reduction of myeloperoxidase activity. Pre-treating animals with latex (40 mg/kg) also inhibited the paw edema induced by histamine, serotonin, bradykinin, prostaglandin E2, compound 48/80. Additionally, the latex (40 mg/kg) reduced the leukocyte peritoneal migration induced by carrageenan and this event was followed by reduction of IL-1β and TNF-α in peritoneal fluid. The latex-treatment (40 mg/kg) reduced the animal abdominal constrictions induced by acetic acid and the first phase on paw licking model induced by formalin. When latex was treated with heat (at 100 °C for 30 min), anti-edematogenic and myeloperoxidase activities were significantly reduced, indicating the involvement of heat-sensitive proteins on anti-inflammatory effect. Our results evidence that latex fluids are a source of proteins with pharmacological properties.

Polysaccharide fraction isolated from Passiflora edulis inhibits the inflammatory response and the oxidative stress in mice.

OBJECTIVES: The aim of the study was to investigate the anti-inflammatory, antioxidant and antinociceptive actions of PFPe, a polysaccharide fraction isolated from the dried fruit of the Passiflora edulis. METHODS: Animals were pretreated with PFPe (0.3, 1 or 3 mg/kg, i.p.) 1 h before induction of paw oedema by carrageenan, histamine, serotonin, compound 48/80 or prostaglandin E2 (PGE2). Neutrophil migration and vascular permeability were measured after carrageenan injection into the peritoneum, and the action of the PFPe on the tumour necrosis factor-alpha, interleukin-1 beta (IL-1ß), myeloperoxidase (MPO), glutathione (GSH) and malondialdehyde (MDA) levels was also evaluated. To assay nociception, we examined acetic acid-induced writhing, formalin-induced paw licking and response latency in the hot plate test. KEY FINDINGS: Pretreatment with PFPe significantly inhibited carrageenan-induced paw oedema. PFPe also reduced paw oedema induced by compound 48/80, histamine, serotonin, and PGE2 and compound 48/80-induced vascular permeability. In addition, PFPe significantly reduced the MPO activity, MDA and GSH concentrations, and IL-1ß level. In the nociception tests, PFPe reduced acetic acid-induced writhing and formalin-induced paw licking and did not increase the response latency time. CONCLUSIONS: Our results suggest that PFPe administration reduces the inflammatory response by modulation of the liberation or synthesis of histamine and serotonin, by reduction of neutrophil migration, IL-1ß levels, and oxidative stress and nociception.

Gabapentin, a synthetic analogue of gamma aminobutyric acid, reverses systemic acute inflammation and oxidative stress in mice.

The aim of this study was to investigate the potential anti-inflammatory and anti-oxidant effects of gabapentin (GBP) in mice. The anti-inflammatory and anti-oxidant effects were evaluated using various mediators that induce paw edema, peritonitis model, myeloperoxidase (MPO) activity, proinflammatory cytokine levels, glutathione (GSH) consumption, and malondialdehyde (MDA) production in mice. Pretreatment of mice with GBP (1 mg/kg) significantly reduced carrageenan or dextran-induced paw edema (P<0.05) when compared to vehicle group. Adding to this, GBP (1 mg/kg) significantly inhibited paw edema induced by histamine, serotonin, bradikinin, 48/80 compound, and prostaglandin E2. In the carrageenan-induced peritonitis model, GBP significantly decreased total and differential leukocyte counts and reduced the levels of MPO activity in the plantar tissue and IL-1ß and TNF-α concentrations in the peritoneal exudate. The same dose of GBP also decreased the MDA concentration and increased the levels of GSH into the peritoneal fluid. In summary, our results demonstrated that GBP exhibited anti-inflammatory activity in mice by reducing the action of inflammatory mediators, neutrophil migration and proinflammatory cytokine levels, and anti-oxidant properties by decreasing the concentration of MDA and increasing the GSH content. These observations raise the possibility that GBP could be used to improve tissue resistance to damage during inflammatory conditions.

Polysaccharides isolated from Digenea simplex inhibit inflammatory and nociceptive responses.

Polysaccharides (PLS) have notably diverse pharmacological properties. In the present study, we investigated the previously unexplored anti-inflammatory and antinociceptive activities of the PLS fraction isolated from the marine red alga Digenea simplex. We found that the PLS fraction reduced carrageenan-induced edema in a dose-dependent manner, and inhibited inflammation induced by dextran, histamine, serotonin, and bradykinin. The fraction also inhibited neutrophil migration into both mouse paw and peritoneal cavity. This effect was accompanied by decreases in IL1-ß and TNF-α levels in the peritoneal fluid. Pre-treatment of mice with PLS (60 mg/kg) significantly reduced acetic acid-induced abdominal writhing. This same dose of PLS also reduced total licking time in both phases of a formalin test, and increased latency in a hot plate test. Therefore, we conclude that PLS extracted from D. simplex possess anti-inflammatory and antinociceptive activities and can be useful as therapeutic agents against inflammatory diseases.

Avaliação do índice de placa bacteriana e sua relação com a condição física e o acondicionamento das escovas dentais / Assessment of plaque index and its relationship with physical fitness and conditioning of toothbrushes

Objetivo: o presente estudo buscou avaliar o índice de placa bacteriana e sua relação com a condição física e o acondicionamento das escovas dentais. Métodos: participaram do estudo 96 crianças em tratamento dentário em uma clínica odontológica de uma universidade privada de Alfenas/MG. Para a coleta de dados, utilizou-se o índice de Performace em Higiene do Paciente. Os dados foram tabulados no GraphPad Prism e tratados estatisticamente. Resultados: a condição física com grau 0 mostrou significância estatística entre os índices: bom e ruim, predominando o índice bom; com o grau 1, entre os índices bom e ruim, bom e péssimo e regular e ruim, predominando o ruim; com o grau 2, entre os índices muito bom e ruim, bom e péssimo, predominando o ruim e bom e ruim, bom e péssimo, predominando o péssimo. Com relação ao acondicionamento das escovas dentais, observou-se que 67,7% das crianças utilizam armarinho e 32,3%, porta-escovas. Conclusão: o maior índice de placa se situou entre regular e ruim, e o bom estado das escovas e o acondicionamento em porta-escovas se relacionaram com menores índices de placa.

Objective: This study aimed to assess the rate of plaque and its relation with physical fitness and conditioning of the toothbrushes. Methods: The study enrollled 96 children in dental treatment in a dental clinic at a private university Alfenas-MG. To collect data we used the Performance Index in Patient Care. Data were plotted in GraphPad Prism and treated statistically. Results: The physical condition with grade 0, showed statistical significance between the indices: good and bad, predominantly good content, with Grade 1, between the indices both good and bad, good and bad and fair and poor, predominantly poor, with grade 2, between the indices very good and bad, good and bad, mainly the bad and good and bad, good and bad, mainly the poor. With respect to packaging of toothbrushes, it was observed that 67.7% of children use haberdashery and 32.3%, brush holders. Conclusion: the plaque index was between fair and poor and good condition of the brushes and brush holders in preparation correlated with lower levels of plaque.