Tarantula cubensis extract (Theranekron®) inhibits inflammation in carrageenan-induced acute paw edema in rats / [Extrato de tarântula cubensis (Theranekron®) inibe a inflamação no edema induzido por algas vermelhas na pata de ratos]

The aim of this study was to investigate the anti-inflammatory effect of alcoholic extract of Tarantula cubensis alcoholic extract (TCAE) in experimentally induced inflammation in rats. Fifty-four adult Sprague-Dawley male rats were randomly divided into nine groups. Paw edema was induced by 0.2mL subplantar (s.p.) injection of 1% carrageenan (CAR) into the right hind paw. Rats were treated with the nonsteroidal anti-inflammatory drug (NSAID) indomethacin (INDO) (10mg/kg, p.o.) or TCAE at different doses (1, 10 or 100µg/kg) injected s.c. for systemic or s.p. for local anti-inflammatory effect. Saline was used as control. Changes in paw thickness, volume, and weight were calculated as percentages. Formalin-fixed paws were used for histopathological examination. We detected that TCAE applied s.c. at 10µg/kg and 100µg/kg doses resulted in thinner paw thickness, lower paw volume, and lower paw weights four hours after the induction of inflammation when compared with the INDO group (p<0.05). The paw edema inhibitory effect of TCAE applied at a dose of 10µg/kg, s.c. was 68% when compared with the INDO which had an inhibitory effect of 56%. These results were verified with similar histopathological findings. The anti-inflammatory feature of 10µg/kg of TCAE given systematically was similar to the effects of INDO. Our results suggest that TCAE has anti-inflammatory effects by reducing edema and decreasing inflammatory reaction. These results may be attributed to the inhibition of the production of proinflammatory mediators. Thus, TCAE may be considered as a potential anti-inflammatory agent for treating acute inflammatory conditions.

O objetivo deste estudo foi investigar o efeito anti-inflamatório do extrato alcoólico de Tarantula cubensis (TCAE) na inflamação induzida experimentalmente em ratos. Cinqüenta e quatro ratos Sprague-Dawley adultos machos foram divididos aleatoriamente em nove grupos. O edema da pata foi induzido pela injeção de 0,2mL de subplantar (s.p.) de 1% de carragena (CAR) na pata traseira direita. Ratos foram tratados com o medicamento antiinflamatório não esteróide (NSAID) indometacina (INDO) (10mg/kg, p.o.) ou TCAE em doses diferentes (1, 10 ou 100µg/kg) injetado s.c. para efeito sistêmico ou s.p. para efeito antiinflamatório local. A soro fisiológico foi usado como controle. As mudanças na espessura da pata, volume e peso foram calculadas como porcentagens. As patas fixadas com fórmalina foram usadas para exame histopatológico. Detectamos que o TCAE aplicado s.c. em doses de 10µg/kg e 100µg/kg resultou em menor espessura da pata, menor volume da pata e menor peso da pata quatro horas após a indução da inflamação quando comparado com o grupo INDO (p<0,05). O efeito inibidor do edema da pata de TCAE aplicado na dose de 10µg/kg, s.c. foi de 68% quando comparado com o INDO que teve um efeito inibidor de 56%. Estes resultados foram verificados com resultados histopatológicos semelhantes. A característica anti-inflamatória de 10µg/kg de TCAE dada sistematicamente foi semelhante aos efeitos do INDO. Nossos resultados sugerem que o TCAE tem efeitos anti-inflamatórios reduzindo o edema e diminuindo a reação inflamatória. Estes resultados podem ser atribuídos à inibição da produção de mediadores pró-inflamatórios. Assim, o TCAE pode ser considerado como um agente antiinflamatório potencial para o tratamento de condições inflamatórias agudas.

Simple scoring system for prediction of mortality in Fournier's gangrene.

PURPOSE: To create new scoring system for prediction of hospital mortality for patients with Fournier's gangrene(FG). MATERIAL AND METHOD: In total, 84 patients with FG were enrolled into this study. The demographic and clinical characteristics of patients were analyzed retrospectively. RESULTS: The mortality rate was 11.9 %. On multivariate analyses, age >60 years, BUN >40 mg/dl, RDW >14.95 %, albumin level <20 mg/dl and presence of sepsis were significant and independent predictors of mortality. The predictive value of our score for mortality was 95.1 %. CONCLUSION: Our scoring system shows adequate discriminatory function for prediction of mortality in patients with FG. Further larger scale studies can improve the performance of our score.

The relationship between arthritis and human parvovirus B19 infection.

In order to evaluate the role of human parvovirus B19 in the etiopathogenesis of autoimmune diseases such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), synovial fluid and blood specimens were collected at 1-month intervals from 20 patients with early synovitis (ES) and 31 with RA. Blood specimens were also collected from 25 patients with SLE, 25 with osteoarthritis (OA) as the diseased control group, and 50 healthy blood donors (HBD) as the healthy control group. Detection of B19 IgM and B19 IgG were performed by enzyme-linked immunosorbent assay from serum specimens, and B19 DNA was detected by polymerase chain reaction from synovial fluid samples. B19 IgM, B19 IgG, and B19 DNA were found in the three patients of the ES group. Subsequently, two of them were diagnosed with RA and one with SLE. B19 DNA was also detected in the synovial fluid of eight patients in the RA group. Of them, all were positive for B19 IgG and half were positive for B19 IgM. B19 IgM was not detected in either of the control groups. To define the role of B19 in the etiopathogenesis and prognosis of undiagnosed arthritis and other chronic inflammatory diseases such as RA and SLE, we need broader serial and prospective studies based on clinical and laboratory collaboration. In conjunction with case reports, these studies would also serve to detect other possible factors in the etiopathogenesis of chronic inflammatory diseases.

Forceps and vacuum delivery: expectations of residency and fellowship training program directors.

The objective of this study is to compare current forceps training practices in North American obstetrical residency training programs with that in maternal-fetal medicine fellowship programs. We sent a survey to all obstetrics and gynecology residency training programs and to all maternal-fetal medicine fellowship programs in North America. After sending out 354 questionnaires, 219 were returned for a response rate of 62%. The response rate for fellowship programs (52 of 59; 88%) was significantly greater than that of residency training programs (167 of 295; 56.6%) (p < 0.05). All fellowship training programs were using the 1988 ACOG forceps classification system, as were 98% of the residency training programs. Eighty-five percent of fellowship directors and 80% of residency directors felt the same system should be used for vacuum deliveries. All residency and fellowship directors expected proficiency with both instruments for outlet deliveries. For low deliveries requiring < or =45 degrees of rotation, at least 92% expected proficiency with both instruments. For low-forceps deliveries with >45 degrees of rotation, 82% of fellowship directors and 80% of residency directors expected proficiency. For low-vacuum deliveries with >45 degrees of rotation, 80% of fellowship directors and 76% of residency directors expected proficiency. Significantly more fellowship directors expected midforceps proficiency (47%) than did residency program directors (38%) (p < 0.05). Midvacuum proficiency was expected by 73% of fellowship directors and 69% of residency directors. The ACOG 1988 forceps classification system has now achieved wide acceptance and is taught by both residency and fellowship program directors. Most program directors favor using the same classification system for vacuum extraction deliveries. In general, the expectations of the residency program directors mirror those of maternal-fetal medicine fellowship directors. While outlet and low operations with < or =45 degrees of rotation are taught and proficiency is expected, most programs no longer expect proficiency in midforceps delivery, but do expect proficiency in midvacuum delivery. Proficiency in low operations with rotations < or =45 degrees is still expected.

Maternal oxygen transport variables during the third trimester of normal pregnancy.

OBJECTIVE: The aim of this study was to measure and calculate oxygen transport variables in uncomplicated term pregnancies. STUDY DESIGN: Ten normotensive primiparous women between 36 and 38 weeks' gestation underwent pulmonary and radial arterial catheterization as part of a larger study. Seven women had studies repeated at approximately 12 weeks post partum. Measurements were made with patients in the left lateral recumbent position after a 30-minute stabilization period. Cardiac output was measured with the thermodilution technique. Blood samples were obtained simultaneously from the pulmonary and radial arteries and analyzed in duplicate for oxygen content with a blood gas analyzer. RESULTS: The oxygen contents of both arterial and mixed venous blood are significantly lower (P <.05) in the third trimester of pregnancy (15.96 and 11.97 mL/dL, respectively) than in the postpartum period (18.00 and 13.54 mL/dL). The fall in oxygen content during pregnancy prevents any significant increase in oxygen delivery in the third trimester (867. 59 mL/min) relative to the postpartum period (806.50 mL/min, P not significant). CONCLUSION: This is the first report of directly measured oxygen transport variables in healthy pregnant women.

The role of forceps rotation in maternal and neonatal injury.

OBJECTIVE: Our purpose was to assess the impact of forceps rotation on maternal and neonatal injury. STUDY DESIGN: In this retrospective case-controlled study performed at the University of Texas Medical Branch at Galveston all forceps deliveries with a rotation of >/=90 degrees performed between July 1992 and September 1995 were identified (n = 113). For controls 167 forceps deliveries with rotations of /=90 degrees accounted for 0.8% of all deliveries. A major fetal injury, defined as a skull fracture, subdural hematoma, brachial plexus or a sixth or seventh cranial nerve injury, occurred in 10.2% of deliveries with rotations of /=90 degrees. The only permanent injury was a brachial plexus palsy that occurred with a forceps rotation of 45 degrees. Rotations of >/=90 degrees were not associated with umbilical arterial acidemia below 7.0 or 7.1 compared with rotations of /=90 degrees were associated with longer maternal hospital stays (P =.009). Neither lacerations of the birth canal, third- or fourth-degree episiotomies, or fall in the maternal hematocrit correlated with the degree of forceps rotation. CONCLUSIONS: Advanced degrees of forceps rotations do not result in any clinically significant increase in infant or maternal morbidity relative to that encountered with lesser degrees of forceps rotation.

The effects of maternal position and cardiac output on intrapulmonary shunt in normal third-trimester pregnancy.

OBJECTIVE: To assess the effect of pregnancy, maternal position, and cardiac output on intrapulmonary shunting (Qs/Qt) in normotensive nulliparous women near term. METHODS: Ten normotensive nulliparas between 36 and 38 weeks' gestation underwent pulmonary artery catheterization (via the subclavian route) and radial artery canalization. Baseline assessments were made with subjects in the left lateral recumbent position after a 30-minute stabilization period. Measurements were obtained sequentially in the left lateral, right lateral, supine, knee-chest, sitting, and standing positions. Each position change was followed by a 10-minute pre-measurement stabilization period. Cardiac output was measured via the thermodilution technique. Blood samples were obtained simultaneously from the pulmonary and radial arteries and analyzed in duplicate for oxygen content with a blood gas analyzer. Qs/Qt was calculated using the classic shunt equation. Statistical analysis was performed by analysis of variance of repeated measures of Qs/Qt and maternal position. The relationship of Qs/Qt to maternal cardiac output was evaluated by the correlation coefficient. Significance was defined as P < .05. RESULTS: Directly measured Qs/Qt averaged 15.3% in left lateral, 15.2% in right lateral, 13.9% in supine, 12.8% in knee-chest, 13.8% in sitting, and 13.0% in standing positions. There was no statistically significant correlation between Qs/Qt and cardiac output (R2 = 0.11, not significant). CONCLUSION: This is the first report of directly measured Qs/Qt in normal pregnant women in the third trimester. Qs/Qt values reported in pregnancy are higher than those reported in nonpregnant individuals.

Third-trimester arterial blood gas and acid base values in normal pregnancy at moderate altitude.

OBJECTIVE: To report arterial blood gas and acid base values of normal nulliparous patients at moderate altitude for commonly used maternal positions. METHODS: Ten normotensive nulliparous women between 36 and 38 weeks' gestation volunteered to undergo radial and pulmonary artery cannulation as part of a larger study. Following instrumentation, baseline assessments were made in the left lateral recumbent position after a 30-minute stabilization period. Sequential measurements were then obtained in the left lateral, right lateral, supine, knee-chest, sitting, and standing positions. Blood samples were analyzed in duplicate for oxygen content on a blood gas analyzer. Statistical analysis was performed by analysis of variance of repeated measures with significance defined at P < or = .05. RESULTS: There was no significant difference in arterial blood gas or acid base values between any positions in this antepartum population of term healthy women. The composite mean values were as follows: pH 7.46, arterial carbon dioxide pressure (PaCO2) 26.6 mmHg, arterial oxygen pressure 88.3 mmHg, bicarbonate 18.2 mEq/L, saturated arterial hemoglobin level 0.96. CONCLUSION: Arterial blood gas and acid base values are not altered by maternal position in the late third trimester of pregnancy. The PaO2 in these women studied at moderate altitude was lower than previously reported for healthy pregnant women studied at sea level. Appropriate interpretation of arterial blood specimens of pregnant women should take into account both the pregnancy and altitude at which the women reside.

Critical care obstetrics: the role of advanced practice nursing.

The role of the advanced practice nurse in the specialty of critical care obstetric nursing is emerging to meet the dynamic needs of health care under reform. Advanced practice components, including case management, research utilization, collaborative consultation, and advanced educational preparation, give light to a new model of caregiver. This article details the educational preparation and specific roles of the advanced practice nurse in the specialty of critical care obstetrics.