Migrainaren tratamendu prebentiboa

Migraina gure gizartean prebalentzia handia duen gaixotasun neurologiko bat da. Berrikuspen bibliografiko honek gaixotasun honi tratamendu prebentibo eraginkor bat topatzea du helburu. Lehenik eta behin tratamendu prebentiboa jasotzeko bete beharreko baldintzak aztertuko dira, era beran tratamenduaren hasieran lagungarriak izan daitezkeen zenbait gomendio emanez. Azken urteotan ikertuak izan diren lau farmako familia dira nagusienak: betablokeanteak, antiepilekektikoak, antidrepesiboak eta kaltzioaren kanal blokeatzaileak. Hala ere farmako talde hauetako medikamentu guztiak ez dira lehen mailako aukerako farmakoak izango. Betablokeanteen artean propanolol eta metoprolol nagusitzen dira migrainen tratamendu profilaktikotzat erabiltzeko orduan. Antiepilektikoen artean topiramato eta azido valproikoa gailentzen dira. Eta azkenik lehen mailako farmakotzat flunarazina, kaltzio kanal blokeatzailea nabarmentzen da. Bigarren mailako farkamoak amitryptilina eta venlafaxina antidepresiboak, bisoprolol eta timolol betablokeatzaileak izan daitezke. Azkenik, hirugarren mailako aukerako farmakoak migrainen profilaxiarako candasartan, lisinopril, toxina botilunikoa, ferverfew, magnesioa, koentzina Q10 eta rivoflavin proposatzen dira. Hala ere, tratamendu farmakologikoaz gain, terapia naturalen eraginkortasuna aztertu nahi da berrikuspen honetan. Emaitza positiboak agertu dira zenbait tratamendu ez farmakologikoetan, haien artean: biofeedback, akupuntura eta dietaren maneiua. Azkenik erizainak pazientearen heziketan izan dezakeen garrantzia aztertuko da. Alde batetik gaixotasuna eta tratamenduari erlazionatutako heziketa emanez, eta bestetik migrainan eragina izan dezaketen zenbait bizi ohituren aldaketa sustatuz.

Pharmacological and immunocytochemical investigation of the role of catecholamines on larval metamorphosis by beta-adrenergic-like receptor in the bivalve Meretrix meretrix

Catecholamines regulate several physiological processes in mollusks. Many pharmacological experiments have been conducted to determine the effects of adrenergic agonist and antagonist of catecholamine receptors on Meretrix meretrix metamorphosis. Results showed that adrenaline (AD) and noradrenaline (NA) had substantial effects (p < 0.05) on larval metamorphosis at concentrations ranging from 10 mu M to 100 mu M. 10 mu M beta-adrenergic receptor (AR) agonist isoproterenol showed the same inducement effect as that of NA and AD on metamorphosis, whereas the alpha-AR agonist phenylephrine had no significant effect at concentrations between 0.1 mu M and 100 mu M concentrations (p > 0.05). Furthermore, I mu M beta-AR antagonist propanolol, but not alpha-AR antagonist prazosin, depressed the larval metamorphosis induced by NA or AD. By immunocytochemistry, two cell bodies of beta-adrenergic-like receptor, C/A1, C/A2, were observed in the cerebral/apical ganglion of competent larvae. In addition, there were other immunoreactive dots near C/A1 and C/A2. The results of pharmacology and immunocytochemistry suggests that beta-adrenergic-like receptor located in the larval CNS, might play a considerable role in the larval metamorphosis of M meretrix by AD or NA. (c) 2006 Elsevier B.V. All rights reserved.

调控文蛤幼虫变态的肾上腺素能受体类型及幼虫发育中神经和肌肉的变化

大部分贝类幼虫在发育过中要经历从浮游生活到底栖生活的变化过程，同时形态结构也要经历巨大的变化，这个过程称为变态。 变态是文蛤幼虫发育过程中非常重要的一个阶段。 药理学和细胞免疫学证据表明β肾上腺素样受体在文蛤幼虫变态过程中有重要作用。药理学实验分别采用了几种儿茶酚胺类受体的激动剂和抑制剂来处理幼虫，检验它们在幼虫变态过程中的作用。结果表明，在10μM和100μM的浓度下，肾上腺素(AD)和去甲肾上腺素(NA)中能够显著提高幼虫的变态率(p<0.05)。10μM和100μM浓度的AD能够提高幼虫变态率30%左右。10μM和100μM浓度的NA能分别提高幼虫变态率35.3%和27.6%。10μM的β受体激动剂－isoproterenol也能够显著的提高幼虫的变态率30%(p<0.05)，但是α受体激动剂－phenylephrine在0.1μM到100μM的浓度范围内不能显著提高幼虫的变态率(p>0.05)。而且，1μM的β受体抑制剂－propanolol能显著的抑制AD或NA提高幼虫变态率的作用(p<0.05)；但是α受体抑制剂－prazosin对AD或NA提高幼虫变态率没有显著性影响(p>0.05)。 此外本文还利用整装免疫细胞化学的方法进一步研究了文蛤幼虫不同发育阶段，神经系统和β肾上腺素样受体的发育情况。 幼虫的神经系统在担轮幼虫时期(受精后18h)开始发育，这时还不能检测到β肾上腺素受体。面盘幼虫时期(受精后1d)具备了顶神经节、脑神经节和脏神经节组成的中枢神经系统，在口附近有一些外周神经。β肾上腺素受体在受精后24h首次出现在面盘幼虫的顶神经节和脑神经节，分别命名为AR(apical receptor)和CR1(cerebral receptor 1)。 在受精后5d顶神经节已经检测不到。脑神经节和脏神经节由腹部向背部迁移，口的背腹两侧都出现了一些神经元。并且脏神经节周围也出现了一些神经细胞。AR在受精后3d就检测不到了。同时在CR1的后部新出现了一些β肾上腺素受体，命名为CR2。此后CR2发育迅速，在受精后5d就和CR1差不多大小。并且在CR1和CR2之间还出现了很多小的阳性信号。 变态过程中中枢神经系统中顶神经节消失了，并且出现了足神经节。另外，外套膜上出现了更多的外周神经。除了在稚贝的脑神经节和脏神经节外，在足、外套膜和水管上都有β肾上腺素受体存在。成体的鳃、足、心脏、水管、唇掰和外套膜上也有β肾上腺素受体分布。 变态信号传递到靶器官后，文蛤幼虫在形态结构和生态习性上开始了快速巨大的变化。其中幼虫的肌肉系统是变化最大的系统，并且直接与文蛤运动、摄食等习性转变相关。本文采用免疫组化的方法对文蛤幼虫肌肉系统的发育进行了研究。结果表明，文蛤幼虫具有由幼虫收缩肌、面盘收缩肌和闭壳肌组成的十分复杂的肌肉系统。幼虫收缩肌和前闭壳肌最早出现于担轮幼虫阶段(受精后18h)。孵化后幼虫的肌肉系统迅速发育，受精后22h幼虫的肌肉系统基本发育完全，并一直维持到变态前。变态过程中幼虫收缩肌和面盘收缩肌逐渐萎缩消失。同时，足收缩肌、后闭壳肌和外套膜肌肉等稚贝的肌肉系统快速形成。变态后稚贝幼虫收缩肌和面盘收缩肌完全消失，其肌肉系统由前后闭壳肌、足收缩肌和外套膜肌肉组成。

Enhanced /3-adrenergic receptors in the brain and pancreas during pancreatic regeneration in weanling rats

Adrenergic stimulation has an inyortant role in the pancreatic It-cell proliferation and insulin secretion. In the present study. we have investigaled how sympathetic system mgulales the panrrealic n I rnerui nr ht an:ilyiing I'pinephi inn 1111 ), Norepinephrinc (NE) and /1-adrenergic receptor changes in the brain as (%eli is in the I swirls. Fill and NII showed a significant decrease in the brain regions, pancreas and plasma :rt 72Ius iller partial prurcrealectonty. We observed an increase in the circulating insulin levels at 72 hrs. Scatchard analysis using I CHI propranolol showed a significant increase in the number of loth the low affinity and high affinity t-adrenergic receplors in cerebral cortex and hypothalamus of partially pancreatectornised rats during peak DNA synthesis. The affinity of the receptors decrea,ed significantly in the low and high affinity receptors of cerebral cortex and the high affinity hypothalamic receptors. In file brain stein, low affinity receptors were increased significantly during regeneration whereas there was no change in the high affinity receptors. The pancreatic ff-adrenergic receptors were also up regulated at 72 firs after partial panerealectony. In vitro studies showed that /i-adrenergic receptors are positive regulators of islet cell proliferation and insulin secretion. Thus our results suggest that the t-adrenergic receptors are functionally enhanced during pancreatic regeneration, which in turn increases pancreatic ft-cell proliferation an(hilisulin secretion in wean hug rats.

Análise da prescrição de medicamentos de pacientes hipertensos atendidos pelo SUS da rede municipal de saúde de Rincão - SP

The purpose of this study was to identify the drugs most often prescribed for hypertension at the Municipal Health Care Center of the town of Rincäo, State of São Paulo, Brazil, and the principal interactions arising from their association with other drugs, both anti-hypertensives and those in other classes. The study included 725 hypertensive patients registered at this health care center who were regularly seen by a physician every three months. Data were collected on age, sex, occurrence of diabetes, smoking, sedentary lifestyle and overweight, to obtain a profile of the hypertensive population of the area. Control records of all patients were available at the pharmacy in the health care center, where patients obtained their drugs once a month. Of the 725 patients, 38% were male and 62% female. Most (57%) were between 50 and 70 years of age, 21% used tobacco and 43% led a sedentary lifestyle. Single-drug therapy accounted for 33% of the prescriptions, multidrug therapy for 66%. In addition to anti-hypertensives, 50% of the patients took drugs of other therapeutic classes. Of those receiving multidrug therapy, 34% used three or more anti-hypertensives and 66% used only two of these drugs. Drug interactions were detected in as many as 47% of the prescriptions. Captopril was the drug that showed most interactions with others (54%), followed by hydrochlorothiazide (27%), furosemide (14%), propanolol (4%), and nifedipine (1%). The analysis revealed that drug consumption by the patients investigated is high, with a concomitantly high number of episodes of drug interaction.

Drug-induced gingival overgrowth: A clinical and histopathological report

Gingival overgrowth is a significant problem faced by periodontists and is particularly associated with the use of certain drugs such as nifedipine, a high-specificity calcium channel blocker used for the treatment and prophylaxis of certain cardiovascular diseases. Development of gingival overgrowth is characterized by increased collagen in gingival tissue. In general is asymptomatic, at times associated with spontaneous bleeding and ulceration and can promote aesthetic changes and compromise hygiene habits and mastication of the patient. The severity of the symptoms is associated with the presence of risk factors such association with other drugs. This paper aims to present a case report of a patient with generalized gingival overgrowth, with more severe characteristics in the anterior mandible induced by chronic use of nifedipine who underwent basic non-surgical periodontal treatment including supra and subgingival scaling and root planning in both jaws associated with rigorous oral hygiene instructions and surgical therapy in the anterior mandible, the most affected area, to remove the excess of gingival tissue. Nifedipine was replaced by the patient cardiologist to propanolol hydrochloride (40 mg/kg) in an attempt to minimize unwanted side effects. After 6 month follow-up, no recurrence was observed, oral hygiene had improved and the patient had clinical periodontal health and esthetic satisfaction.

Pharmacological interventions in the treatment of the acute effects of cannabis: a systematic review of literature

Abstract Background Cannabis intoxication is related to a number of physical and mental health risks with ensuing social costs. However, little attention has been given to the investigation of possible pharmacological interactions in this condition. Objective To review the available scientific literature concerning pharmacological interventions for the treatment of the acute effects of cannabis. Methods A search was performed on the Pubmed, Lilacs, and Scielo online databases by combining the terms cannabis, intoxication, psychosis, anxiety, and treatment. The articles selected from this search had their reference lists checked for additional publications related to the topic of the review. Results The reviewed articles consisted of case reports and controlled clinical trials and are presented according to interventions targeting the physiological, psychiatric, and cognitive symptoms provoked by cannabis. The pharmacological interventions reported in these studies include: beta-blockers, antiarrhythmic agents, antagonists of CB-1 and GABA-benzodiazepine receptors, antipsychotics, and cannabidiol. Conclusion Although scarce, the evidence on pharmacological interventions for the management of cannabis intoxication suggests that propanolol and rimonabant are the most effective compounds currently available to treat the physiological and subjective effects of the drug. Further studies are necessary to establish the real effectiveness of these two medications, as well as the effectiveness of other candidate compounds to counteract the effects of cannabis intoxication, such as cannabidiol and flumazenil.

Diagnóstico, pronóstico y tratamiento de la taquicardia ventricular polimórfica catecolaminérgica : estudio prospectivo en una familia de Gran Canaria con alta incidencia de muerte súbita.

Programa de doctorado: Avances en medicina interna.

Role of β-adrenergic receptors in the oral activity of zinc-α2-glycoprotein (ZAG)

Zinc-a2-glycoprotein (ZAG) is an adipokine with the potential as a therapeutic agent in the treatment of obesity and type 2 diabetes. In this study we show that human ZAG, which is a 41-kDa protein, when administered to ob/ob mice at 50 µg/d-1 orally in the drinking water produced a progressive loss of body weight (5 g after 8 d treatment), together with a 0.5 C increase in rectal temperature and a 40% reduction in urinary excretion of glucose. There was also a 33% reduction in the area under the curve during an oral glucose tolerance test and an increased sensitivity to insulin. These results were similar to those after iv administration of ZAG. However, tryptic digestion was shown to inactivate ZAG. There was no evidence of human ZAG in the serum but a 2-fold elevation of murine ZAG, which was also observed in target tissues such as white adipose tissue. To determine whether the effect was due to interaction of the human ZAG with the ß-adrenergic (ß-AR) in the gastrointestinal tract before digestion, ZAG was coadministered to ob/ob mice together with propanolol (40 mg/kg-1), a nonspecific ß-AR antagonist. The effect of ZAG on body weight, rectal temperature, urinary glucose excretion, improvement in glucose disposal, and increased insulin sensitivity were attenuated by propanolol, as was the increase in murine ZAG in the serum. These results suggest that oral administration of ZAG increases serum levels through interaction with a ß-AR in the upper gastrointestinal tract, and gene expression studies showed this to be in the esophagus.

La balance sympatho-vagale et le bruxisme du sommeil

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

La balance sympatho-vagale et le bruxisme du sommeil

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.