Digoxin serum levels in patients with Chagas' cardiomyopathy and heart failure

INTRODUCTION: The purpose of this study was to determine digoxin serum concentrations in patients with Chagas' cardiomyopathy with chronic heart failure, because little is known concerning this laboratory test in patients with this condition. METHODS: This study focuses on 29 (29%) out of 101 patients with chronic heart failure secondary to Chagas' cardiomyopathy receiving digoxin therapy. Digoxin was measured by the immune-enzymatic method. RESULTS: New York Heart Association Functional Class III/IV was noted in 13 (45%) patients. The mean potassium serum level was 4.3± 0.5mEq/L, mean creatinine serum levels 1.4± 0.3dg/100ml, and left ventricular ejection fraction 34.7± 13.8%. The median digoxin serum level was 1.27 (0.55; 1.79)ng/ml. Sixteen (55%) patients had digoxin serum levels higher than 1.0ng/ml. Abnormal digoxin serum levels were verified in 13 (45%) patients. Digoxin serum levels correlated moderately with creatinine serum levels (r = 0.39; p< 0.03) and negatively with sodium serum levels (r= -0.38; p= 0.03). CONCLUSIONS: Digoxin serum concentration should be measured in patients with Chagas' cardiomyopathy with chronic heart failure receiving digoxin therapy due to the potential for digoxin toxicity.

Analysis of the chemical components of hydatid fluid from Echinococcus granulosus

Introduction The aim of this study was to explore the environment of Echinococcus granulosus (E. granulosus) protoscolices and their relationship with their host. Methods Proteins from the hydatid-cyst fluid (HCF) from E. granulosus were identified by proteomics. An inductively coupled plasma atomic emission spectrometer (ICP-AES) was used to determine the elements, an automatic biochemical analyzer was used to detect the types and levels of biochemical indices, and an automatic amino acid analyzer was used to detect the types and levels of amino acids in the E. granulosus HCF. Results I) Approximately 30 protein spots and 21 peptide mass fingerprints (PMF) were acquired in the two-dimensional gel electrophoresis (2-DE) pattern of hydatid fluid; II) We detected 10 chemical elements in the cyst fluid, including sodium, potassium, calcium, magnesium, copper, and zinc; III) We measured 19 biochemical metabolites in the cyst fluid, and the amount of most of these metabolites was lower than that in normal human serum; IV) We detected 17 free amino acids and measured some of these, including alanine, glycine, and valine. Conclusions We identified and measured many chemical components of the cyst fluid, providing a theoretical basis for developing new drugs to prevent and treat hydatid disease by inhibiting or blocking nutrition, metabolism, and other functions of the pathogen.

Bowel preparation for colonoscopy: comparison of mannitol and sodium phosphate. Results of a prospective randomized study

METHOD: Eighty patients were prospectively randomized for precolonoscopic cleansing either with 750 ml of 10% mannitol (Group M) or 180 ml of a sodium phosphate preparation (Group NaP). Laboratory examinations before and after preparation on all patients included hemoglobin, hematocrit, sodium, potassium, phosphorous, calcium and serum osmolarity. A questionnaire was used to assess undesirable side effects and patient tolerance to the solution. The quality of preparation was assessed by the endoscopist who was unaware of the solution employed. RESULTS: Statistically significant changes were verified in serum sodium, phosphorous, potassium and calcium between the two groups, but no clinical symptoms were observed. There were no significant differences in the frequency of side effects studied. Six of the eight patients in Group NaP who had taken mannitol for a previous colonoscopy claimed better acceptance of the sodium phosphate solution. The endoscopic-blinded trial reported excellent or good bowel preparation in 85% prepared with sodium phosphate versus 82.5% for mannitol (p=0.37). CONCLUSIONS: Quality of preparation and frequency of side effects was similar in the two solutions. The smaller volume of sodium phosphate necessary for preparation seems to be related to its favorable acceptance. Nevertheless, the retention of sodium and phosphate ions contraindicates the use of sodium phosphate in patients with renal failure, cirrhosis, ascites, and heart failure.

Laboratory assessment of the hypertensive individual. Value of the main guidelines for high blood pressure

OBJECTIVE: To determine if abnormal laboratory findings are more common in individuals with hypertension and in those with other risk factors, such as obesity, smoking and alcohol ingestion. METHODS: A study was carried out in the general outpatient clinics of a university hospital (145 individuals without previous diagnosis of hypertension) and the following variables were assessed: high blood pressure (as defined by the VI Joint National Committee on Prevention, Detection and Treatment of High Blood Pressure - VI JNC), obesity [calculated using body mass index (BMI)], tobacco use, and alcoholic ingestion. The laboratory examinations consisted of the following tests: hemogram, glycemia, uric acid, potassium, total/HDL-fraction cholesterol, triglycerides, calcium and creatinine. RESULTS: High blood pressure was not associated with a higher number of abnormal laboratory tests. Hypertensive individuals with a BMI > or = 25kg/m² or normotensive obese individuals, however, had a higher frequency of diabetes (12X), hypertriglyceridemia (3X), and hypercholesterolemia (2X), as compared with hypertensive individuals with BMI <25kg/m² and preobese/normal weight normotensive individuals. CONCLUSION: High blood pressure is not associated with a higher frequency of abnormal laboratory tests. The association of high blood pressure and obesity, however, increases the detection of diabetes and dyslipidemias.

Influence of ischemic preconditioning in myocardial protection in patients undergoing myocardial revascularization with intermittent crossclamping of the aorta. Analysis of ions and blood gases

OBJECTIVE: To test the hypothesis that short periods of ischemia may increase the myocardial protection obtained with intermittent crossclamping of the aorta. METHODS: In the control group (18 patients), surgery was performed with systemic hypothermia at 32ºC and intermittent crossclamping of the aorta. Extracorporeal circulation was used. In the preconditioning group (17 patients), 2 crossclampings of the aorta lasting 3min each were added prior to the intermittent crossclamping of the conventional technique with an interval of 2min of reperfusion between them. Blood samples for analyses of pH, pCO2, pO2, sodium, potassium, calcium, and magnesium were obtained from the coronary sinus at the beginning of extracorporeal circulation (time 1), at the end of the first anastomosis (time 2), and at the end of extracorporeal circulation (time 3). RESULTS: No difference was observed in the results of the 2 groups, except for a variation in the ionic values in the different times of blood withdrawal; sodium values, however, remained stable. All patients had a good clinical outcome. CONCLUSION: The results of intermittent crossclamping of the aorta with moderate hypothermia were not altered by the use of ischemic preconditioning.

The Yanomami indians in the INTERSALT study

OBJECTIVE: To study the distribution and inter-relationship among constitutional and biochemical variables with blood pressure (BP) in an population of Yanomami indians. To compare these findings with those of other populations. METHODS: The Yanomami indians were part of the INTERSALT, a study comprising 10,079 males and females, aged from 20 to 59 years, belonging to 52 populations in 32 countries in Africa, the Americas, Asia, and Europe. Each of the 52 centers was required to accrue 200 individuals, 25 participants in each age group. The variables analyzed were as follows: age, sex, arterial BP, urinary sodium and potassium excretion (24-hour urine), body mass index, and alcohol ingestion. RESULTS: The findings in the Yanomami population were as follows: a very low urinary sodium excretion (0.9 mmol/24h); mean systolic and diastolic BP levels of 95.4 mmHg and 61.4 mmHg, respectively; no cases of hypertension or obesity; and they have no knowledge of alcoholic beverages. Their BP levels do not elevate with age. The urinary sodium excretion relates positively and the urinary potassium excretion relates negatively to systolic BP. This correlation was maintained even when controlled for age and body mass index. CONCLUSION: A positive relation between salt intake and blood pressure was detected in the analysis of a set of diverse populations participating in the INTERSALT Study, including populations such as the Yanomami Indians. The qualitative observation of their lifestyle provided additional information.

Endothelium-dependent relaxation in response to poly-L-arginine in canine coronary arteries: implications about hyperpolarization as a mechanism of vasodilatation

OBJECTIVE: To study the mechanism by which poly-L-arginine mediates endothelium-dependent relaxation. METHODS: Vascular segments with and without endothelium were suspended in organ chambers filled with control solution maintained at 37ºC and bubbled with 95% O2 / 5% CO2. Used drugs: indomethacin, acetycholine, EGTA, glybenclamide, ouabain, poly-L-arginine, methylene blue, N G-nitro-L-arginine, and verapamil and N G-monomethyl-L-arginine. Prostaglandin F2á and potassium chloride were used to contract the vascular rings. RESULTS: Poly-L-arginine (10-11 to 10-7 M) induced concentration-dependent relaxation in coronary artery segments with endothelium. The relaxation to poly-L-arginine was attenuated by ouabain, but was unaffected by glybenclamide. L-NOARG and oxyhemoglobin caused attenuation, but did not abolish this relaxation. Also, the relaxations was unaffected by methylene blue, verapamil, or the presence of a calcium-free bathing medium. The endothelium-dependent to poly-L-arginine relaxation was abolished only in vessels contracted with potassium chloride (40 mM) in the presence of L-NOARG and indomethacin. CONCLUSION: These experiments indicate that poly-L-arginine induces relaxation independent of nitric oxide.

Hypertensive diabetic patients: guidelines for conduct and their difficulties

OBJECTIVE: To assess the effect of blood pressure (BP) control and other cardiovascular risk factors in patients with diabetes mellitus in a referral service for the treatment of hypertension. METHODS: A retrospective study where diabetic patients (at least 2 fasting glucose levels above 126 mg/dL, use of hypoglycemic agents or insulin, or both of these) were included. They were evaluated at the first appointment (M1) and at the last appointment (M2), regarding blood pressure, body mass index (BMI), use of hypertensive drugs, glycemia, total cholesterol (TC), creatinine, and potassium. RESULTS: Of 1,032 patients studied, 146 patients with a mean age of 61.6 years had diabetes, and 27 were men (18.5%). Mean follow-up was 5.5 years. BP values were 161.6 x 99.9 mmHg in M1 and 146.3 x 89.5 mmHg in M2. In M1, 10.4% of the patients did not use medications, 50.6% used just 1 drug, 30.8% used 2 drugs, and 8.2% used 3 or more drugs. In M2, these values were 10.9%, 39%, 39.7%, and 10.4%, respectively. Diuretics were the most commonly used medication, whereas angiotensin-converting enzyme inhibitors (ACE inhibitors) were those drugs which presented greater increase when comparing M1 to M2 (24.6% and 41.7%, respectively). Only 17,1% reached the recommended goal (BP<130x85 mmhg). The other cardiovascular risk factors did not change significantly. CONCLUSION: Our data reinforce the necessity of a more aggressive approach in the treatment of these patients, despite the social and economic difficulties in adhering to treatment.

Impact of Light Salt Substitution for Regular Salt on Blood Pressure of Hypertensive Patients

Background: Studies have shown sodium restriction to have a beneficial effect on blood pressure (BP) of hypertensive patients. Objective: To evaluate the impact of light salt substitution for regular salt on BP of hypertensive patients. Methods: Uncontrolled hypertensive patients of both sexes, 20 to 65 years-old, on stable doses of antihypertensive drugs were randomized into Intervention Group (IG - receiving light salt) and Control Group (CG - receiving regular salt). Systolic BP (SBP) and diastolic BP (DBP) were analyzed by using casual BP measurements and Home Blood Pressure Monitoring (HBPM), and sodium and potassium excretion was assessed on 24-hour urine samples. The patients received 3 g of salt for daily consumption for 4 weeks. Results: The study evaluated 35 patients (65.7% women), 19 allocated to the IG and 16 to the CG. The mean age was 55.5 ± 7.4 years. Most participants had completed the Brazilian middle school (up to the 8th grade; n = 28; 80.0%), had a family income of up to US$ 600 (n = 17; 48.6%) and practiced regular physical activity (n = 19; 54.3%). Two patients (5.7%) were smokers and 40.0% consumed alcohol regularly (n = 14). The IG showed a significant reduction in both SBP and DBP on the casual measurements and HBPM (p < 0.05) and in sodium excretion (p = 0.016). The CG showed a significant reduction only in casual SBP (p = 0.032). Conclusions: The light salt substitution for regular salt significantly reduced BP of hypertensive patients.

Electrical Properties of Isolated Cardiomyocytes in a Rat Model of Thiamine Deficiency

In modern society, thiamine deficiency (TD) remains an important medical condition linked to altered cardiac function. There have been contradictory reports about the impact of TD on heart physiology, especially in the context of cardiac excitability. In order to address this particular question, we used a TD rat model and patch-clamp technique to investigate the electrical properties of isolated cardiomyocytes from epicardium and endocardium. Neither cell type showed substantial differences on the action potential waveform and transient outward potassium current. Based on our results we can conclude that TD does not induce major electrical remodeling in isolated cardiac myocytes in either endocardium or epicardium cells.

Mechanisms Involved in Exercise-Induced Cardioprotection: A Systematic Review

Background:Acute myocardial infarction is the leading cause of morbidity and mortality worldwide. Furthermore, research has shown that exercise, in addition to reducing cardiovascular risk factors, can also protect the heart against injury due to ischemia and reperfusion through a direct effect on the myocardium. However, the specific mechanism involved in exerciseinduced cardiac preconditioning is still under debate.Objective:To perform a systematic review of the studies that have addressed the mechanisms by which aerobic exercise promotes direct cardioprotection against ischemia and reperfusion injury.Methods:A search was conducted using MEDLINE, Literatura Latino-Americana e do Caribe de Informação em Ciências da Saúde, and Scientific Electronic Library Online databases. Data were extracted in a standardized manner by two independent researchers, who were responsible for assessing the methodological quality of the studies.Results:The search retrieved 78 studies; after evaluating the abstracts, 30 studies were excluded. The manuscripts of the remaining 48 studies were completely read and, of these, 20 were excluded. Finally, 28 studies were included in this systematic review.Conclusion:On the basis of the selected studies, the following are potentially involved in the cardioprotective response to exercise: increased heat shock protein production, nitric oxide pathway involvement, increased cardiac antioxidant capacity, improvement in ATP-dependent potassium channel function, and opioid system activation. Despite all the previous investigations, further research is still necessary to obtain more consistent conclusions.

Effects of One Resistance Exercise Session on Vascular Smooth Muscle of Hypertensive Rats

AbstractBackground:Hypertension is a public health problem and increases the incidence of cardiovascular diseases.Objective:To evaluate the effects of a resistance exercise session on the contractile and relaxing mechanisms of vascular smooth muscle in mesenteric arteries of NG-nitro L-arginine methyl ester (L-NAME)-induced hypertensive rats.Methods:Wistar rats were divided into three groups: control (C), hypertensive (H), and exercised hypertensive (EH). Hypertension was induced by administration of 20 mg/kg of L-NAME for 7 days prior to experimental protocols. The resistance exercise protocol consisted of 10 sets of 10 repetitions and intensity of 40% of one repetition maximum. The reactivity of vascular smooth muscle was evaluated by concentration‑response curves to phenylephrine (PHEN), potassium chloride (KCl) and sodium nitroprusside (SNP).Results:Rats treated with L-NAME showed an increase (p < 0.001) in systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) compared to the initial period of induction. No difference in PHEN sensitivity was observed between groups H and EH. Acute resistance exercise reduced (p < 0.001) the contractile response induced by KCl at concentrations of 40 and 60 mM in group EH. Greater (p < 0.01) smooth muscle sensitivity to NPS was observed in group EH as compared to group H.Conclusion:One resistance exercise session reduces the contractile response induced by KCl in addition to increasing the sensitivity of smooth muscle to NO in mesenteric arteries of hypertensive rats.

Influência do cloro, sôbre a composição do caldo da cana de açúcar Co 290, aplicado no solo, na forma de cloreto de sódio

Considering the economic importance of the sugar industry among ourselves, the authors carried out a field experiment (Latin square) with Co 290 sugar cane, on a white sandy soil of Piracicaba, State of São Paulo, Brazil, applying NaCl in increasing rates (from 6.8 to 54.5 grams per plant), in order to study the effects of chlorides, on productivity and on the composition of juice. No toxic or stimulating effect was found, and there was no change in yield, in degree of purity of the juice, in general aspect of plants or in colour of leaves and culms. No difference was observed between potassium sulphate or chloride, as source of potash for sugar cane culture. Data collected and the literature cited suggest: (a) that the use of the variety Co 290 is indicated for soils rich in chlorine, such as the saline soils of the North-east and Atlantic Coast of Brazil; (b) that it is necessary to extend studies in Research Institutes and Agricultural Experiment Stations of the country to verify the behaviour of other varieties of sugar cane in the types of soils mentioned, especially with respect their yielding capacity. The authors are already planning such investigations.

Estudos sobre o «vermelhão» do algodoeiro (III)

In several cotton crops areas of the State of S. Paulo it was observed, during the years of 1948, 1949, and 1951, the appearance of a purple color of the leaves; the color appears in the opening of the bolls and was correlated with a decrease of production. The opinions concerning the cause of such abnormality were very different and sometimes contradictory; certain investigators attributed the disease to insect attack, others to bad climatic conditions whereas others to a potassium deficiency now called "fome de potássio" (potash hunger); our ideas on the subject is another one. We think that the disease is caused by lack of a suitable supply of magnesium. This opinion is largely based on the syntomatology found in the literature. To study the problem, several experiments were carried out, namely: 1. pot experiments using soil collected in areas where the disorder had appeared; 2. pot experiments controlling the water supply; 3. sand culture experiments omitting either potassium or magnesium; 4. leaf analysis of plant matrial collected troughout the Piracicaba County; 5. plot experiments with the varieties Texas, Express, and I.A. 817 Campinas. The first four experiments were discussed elsewhere. To study the point 5 an experiment was carried out, with the following treatments : 1 - NPKCaMg (no K added) - Mg supplied as MgSO4 (a soluble form); 2 -NPKCa (no Mg added); 3 -NPKCaMg (complete) - Mg supplied as MgSO4; 4 - NPKCaMg (complete) - Mg supplied as dolomitic limestone (a slightly soluble form) as a rate 2.5 higher than in the treatment 1 and 3. Organic matter as cottonseed meal was applied in the proportion of 500 kg per hectare. The experimental design was randomized blocks with 4 replications and the results can be summarized as follows: 1 the I.A 817 variety was the most strongly affected by the physiological disorder, with severe decrease in yield; 2. the disease occurred more frequently in the minus magnesium treatment; 3. dolomitic limestone is so effective as magnesium sulfate in the control of the disease as well in the raising of the yield; 4. in the minus K treatment it was observed a marked occurrence of the typical symptoms of potassium deficiency (cotton rust); 5. magnesium was actually, in the experimental conditions the responsible for the purple color (vermelhão) of the cotton leaves.

Contribuição ao estudo do «vermelhão» do algodoeiro (Gossipium herbaceum)

During the years 1948, 1949 and 1951 a disease occurred in the cotton crops of the state of S. Paulo Brazil (S. Am.), which caused a severe drop in yields. The abnormality was characterized by a typical reddish - purple color of the leaves, being by this reason, called "vermelhão", that is, reddening of the cotton plant. The disease was associated with a dry season. Among the several hypotheses raised to explain the causes of the disease were: insect attack, potassium deficiency - where from the name "potash hunger" was also given -, and magnesium deficiency: In order to study the problem the Department of Agricultural Chemistry of the College of Agriculture of the University of São Paulo, at Piracicaba, carried out a series of experiments as follows: 1. pot experiments in which soil of one of the affected regions was used ("terra roxa", a red-brownish soil derived from basalt); 2. pot-soil experiments varying the moisture supplied; 3. sand culture experiments omitting certain elements from the nutrient solutions; 4. field plot experiments, conducted on a sandy soil; three different varieties were employed: Texas, Express, and I.A. 817; magnesium was applied either as sulfate or dolomitic limestone. All the experiments were completed with suitable chemical analyses. The results can be summarized as follows: 1. in the first trial, the not properly manured pots (minus Mg), symptoms were registered which were similar to the symptoms observed in the field; it was possible to establish some differences among three different types of reddening: due to lack of K in the mixed fertilizers used, the characteristic cotton rust made its appearance, the red color in the leaves of the minus Mg plants was all alike that described in the current literature as a symptom of Mg-deficiency; in all the treatments ocurred a yellow-reddish color in the leaves associated with the latest stages of maturity; 2. in the second experiment it was verified that when the plants in the pots with soil were kept 75 per cent of the water holding capacity, no symptom of deficiency showed up; was true even for the plants not receiving neither K nor Mg; however, plants supplied with only 25 per cent of the water holding capacity showed, respectively, cotton rust in the minus K treatment and the red purplish color in the minus Mg series; 3. the sand culture experiment confirmed lack of Mg as the cause of "vermelhão", being potash deficiency the responsible for cotton rust; 4. in the field experiment, variety LA. 817 revealed to be the most sensitive to "vermelhão" when Mg was omitted from the fertilizers; symptoms of K deficiency appeared when no K was supplied; both magnesium sulfate and dolomitic limestone proved to be equally effective in the control of "vermelhão"; 5. the analyses of material collected both in the field as well in the pots revealed that leaf petiole in the most reliable part to indicate the K and Mg status of the plant; the variation in Mg content suffered by the plants showing different stages of "vermelhão was, quantitatively, at least as large as that in K content, however when one deals with K deficient plants, that is, plants showing the typical rust, no variation occurred in the Mg content, whereas K in the dry mater dropped from more than 1 per cent to less than half per cent. Then, the following general conclusions can be drawn: 1. Mg deficiency is the cause of "vermelhão" of cotton crops; 2. K deficiency also occurred, but in a lesser degree; 3. the climate conditions - especially the lack of rain influenced the soil dynamic of K, and especially Mg, bringing a severe reduction in their assimilability; 4. the "vermelhão" disease can be easily controlled upon additions either of magnesium sulfate or dolomitic limestone.