Alteraciones de la glucemia en anestesia general con halotano vs. fentanyl. Hospital José Carrasco Arteaga (IESS).1997

Se realiza un estudio clínico cuasi experimental, de valoración comparativa entre dos métodos anestésicos: Halotano vs. Fentanyl, en pacientes sometidos a cirugía, en el hospital José Carrasco Arteaga [IESS] de la ciudad de Cuenca, durante el año 1997. Se conformaron dos grupos de 50 pacientes, de 15 a 64 años de edad. El primer grupo recibió dosis respuesta de halotano y el segundo grupo que recibió fentanyl fue a dosis de 5 mcg/kg para la inducción y bolos de 50 al 100 mcg cada 15 a 30 minutos para mantenimiento. Se hicieron determinaciones de glucemia durante el pre, trans y posoperatorio, utilizando el glucotest [tiras reactivas]. Se concluye que cuando el anestésico utilizado es el fentanyl los niveles de glucosa difieren significativamente en el trans y posoperatorio, en comparación con el grupo de pacientes a los que se les administró halotana. [p<0.001] se sugiere el uso de TIVA: fentanyl por la analgesia y protección neurovegetativa, dando seguridad y eficiencia al paciente y al anestesiólogo. Además recomendamos realizar estudios en pacientes diabéticos o sometidos a alto estrés quirúrgico. Se acompaña bibliografía actualizada sobre el tema

Premedicación con midazolam vía oral en pacientes pediátricos, Hospitales Vicente Corral Moscoso, José Carrasco Arteaga Cuenca 1996 -1997

Objetivos: Disminuir la ansiedad y el estrés que presentan los niños que van a ser sometidos a intervenciones quirúrgicas, antes de ingresar a la sala de operaciones. Materiales y Métodos: Se incluyeron 128 niños de ambos sexos, ASA I-II entre 1 y 12 años, sometidos a cirugía en los hospitales José Carrasco de IESS y Vicente Corral del MSP, de la ciudad de Cuenca, desde noviembre de 1996 hasta noviembre de 1997. Se formaron dos grupos aleatorizados: a] grupo CON MIDAZOLAM [Mz], 64 niños a los que se administró midazolam por vía oral 0.25 mg/kg, diluido en +- 5 ml. de una solución azucarada 30 min. antes de la inducción anestésica, y b] grupo SIN MIDAZOLAM [Ctrl], 64 pacientes para control a los que se adminstró únicamente solución azucarada. Ambos grupos tuvieron valoración clínica y de laboratorio. Se monitorizó los signos vitales antes de la premedicación, a los 30 min. de ella y en el transanestésico. Para valoración del estado emocional se utilizó una escala visual semejante a la escala Oucher. Resultados: la edad promedio en el grupo Mz fue de 5.89 +- 1.65 años y en el grupo Ctrl de 5.23 +- 1.24 años. El peso promedio en el grupo Mz fue de 14.98 +- 4.58 kg. y en grupo Ctrl de 15.35 +- 7.35 kg. Las diferencias no fueron significaticas. Hubo un predominio de varones en ambos grupos dependiente del tipo de intervención, cerca del 70 por ciento de las intervenciones fueron de urología y traumatología y ortopedia. En el grupo Mz se registró una mayor disminución de la respiración, frecuencia cardíaca y tensión arterial [p<0.05]. La Sp02 fue menor en el grupo Mz pero la respuesta psicológica a la inducción anestésica fue mayor [p<0.05]. Hubo un 6.25 por ciento de reacciones secundarias como mareo, diaforesis y somnolencia. Conclusiones: Los niños de 1 a 12 años que se someten a ciurugías ambulatorias y que son premedicados con midazolam, presentan: sedación, tranquilidad y disminución de: oximetría, tensión arterial tanto sistólica como diastólica, frecuencia cardíaca y frecuencia respiratoria, dentro de valores fisiológicamente tolerables

Tiempo de bloqueo sensitivo y motor, y variaciones de presión sanguínea, frecuencia cardíaca y saturación de oxígeno arterial con diferentes dosis de ropivacaína: 7.5, 10 y 12.5 mg, asociados a 25 microgramos de fentanil para anestesia espinal, Hospital José Carrasco, Cuenca 2005

Especialista en Anestesiología

Innovation and Territorial Development: An Analysis of the Region of São José dos Campos - Brazil

This study aimed to identify and analyze the interrelations between companies, research centers, universities, government and other relevant players in the micro region of São José dos Campos, focusing on the creation and diffusion of innovations as a strategy for regional development. To this end, we made an interview with 12 regional players Involved in this process. It is hoped the results expand the knowledge of regional development in technologyoriented areas, as well as the dynamics of territorial development in the micro region studied. It is an academic contribution in developing strategies for expanding competitive regions through incentives for innovation and technology transfer.

Crisis afásica simulando un ataque cerebrovascular isquémico agudo en el Servicio de Neurología del Hospital de San José de Bogotá DC

Se ha demostrado que la afasia como fenómeno ictal o postictal, se observa en cerca del 17% de los pacientes. Los casos en que es el único síntoma ictal, como en el estado epiléptico afásico, podría presentar un reto diagnóstico, y dependen de la sospecha diagnóstica del clínico. Presentamos el caso de un adulto mayor, que llega a urgencias por una alteración del lenguaje. Fue enfocado como un ataque cerebrovascular isquémico, pero después de evaluar la imagen de resonancia magnética cerebral simple se solicitó videotelemetría, que mostró descargas epileptiformes lateralizadas en región temporal izquierda, por lo que el paciente fue manejado como un estatus de afasia, con mejoría.

Implantação do protocolo de organização do serviço de enfermagem na Unidade Básica de Saúde Padre José Jorge Nicolau, Ibituruna, Minas Gerais

Este estudo baseia-se em uma revisão bibliográfica narrativa e elaboração de Protocolo de Organização dos Serviços de Enfermagem na Unidade Básica de Saúde (UBS) Padre José Jorge Nicolau, Ibituruna, Minas Gerais. O planejamento em saúde vem se tornando a cada dia uma realidade, pois através deste temos maior probabilidade de alcançar metas e atingir nossos objetivos. A enfermagem tem um campo amplo de atuação, e na atenção primária podemos ver os benefícios de sua contribuição para a melhoria da assistência à população. Nesse contexto, os protocolos de cuidados à saúde e de organização dos serviços de saúde, vêm para facilitar, por meio de padronizações, as condutas de enfermagem. No intuito de garantir uma assistência de enfermagem de boa qualidade e respaldada nos preceitos éticos e administrativos, torna-se necessário a criação e implantação de um protocolo de organização do serviço de enfermagem, com ajustes do modelo atual para garantir melhorias tanto para a enfermagem quanto para a população assistida.

Molecular And Biochemical Characterization Of Caffeine Synthase And Purine Alkaloid Concentration In Guarana Fruit.

Guarana seeds have the highest caffeine concentration among plants accumulating purine alkaloids, but in contrast with coffee and tea, practically nothing is known about caffeine metabolism in this Amazonian plant. In this study, the levels of purine alkaloids in tissues of five guarana cultivars were determined. Theobromine was the main alkaloid that accumulated in leaves, stems, inflorescences and pericarps of fruit, while caffeine accumulated in the seeds and reached levels from 3.3% to 5.8%. In all tissues analysed, the alkaloid concentration, whether theobromine or caffeine, was higher in young/immature tissues, then decreasing with plant development/maturation. Caffeine synthase activity was highest in seeds of immature fruit. A nucleotide sequence (PcCS) was assembled with sequences retrieved from the EST database REALGENE using sequences of caffeine synthase from coffee and tea, whose expression was also highest in seeds from immature fruit. The PcCS has 1083bp and the protein sequence has greater similarity and identity with the caffeine synthase from cocoa (BTS1) and tea (TCS1). A recombinant PcCS allowed functional characterization of the enzyme as a bifunctional CS, able to catalyse the methylation of 7-methylxanthine to theobromine (3,7-dimethylxanthine), and theobromine to caffeine (1,3,7-trimethylxanthine), respectively. Among several substrates tested, PcCS showed higher affinity for theobromine, differing from all other caffeine synthases described so far, which have higher affinity for paraxanthine. When compared to previous knowledge on the protein structure of coffee caffeine synthase, the unique substrate affinity of PcCS is probably explained by the amino acid residues found in the active site of the predicted protein.

Profile Of The Use Of Disease Modifying Drugs In The Brazilian Registry Of Spondyloarthritides.

Few studies have evaluated the profile of use of disease modifying drugs (DMD) in Brazilian patients with spondyloarthritis (SpA). A common research protocol was applied prospectively in 1505 patients classified as SpA by criteria of the European Spondyloarthropathies Study Group (ESSG), followed at 29 referral centers in Rheumatology in Brazil. Demographic and clinical variables were obtained and evaluated, by analyzing their correlation with the use of DMDs methotrexate (MTX) and sulfasalazine (SSZ). At least one DMD was used by 73.6% of patients: MTX by 29.2% and SSZ by 21.7%, while 22.7% used both drugs. The use of MTX was significantly associated with peripheral involvement, and SSZ was associated with axial involvement, and the two drugs were more administered, separately or in combination, in the mixed involvement (p < 0.001). The use of a DMD was significantly associated with Caucasian ethnicity (MTX , p = 0.014), inflammatory back pain (SSZ, p = 0.002) , buttock pain (SSZ, p = 0.030), neck pain (MTX, p = 0.042), arthritis of the lower limbs (MTX, p < 0.001), arthritis of the upper limbs (MTX, p < 0.001), enthesitis (p = 0.007), dactylitis (MTX, p < 0.001), inflammatory bowel disease (SSZ, p < 0.001) and nail involvement (MTX, p < 0.001). The use of at least one DMD was reported by more than 70% of patients in a large cohort of Brazilian patients with SpA, with MTX use more associated with peripheral involvement and the use of SSZ more associated with axial involvement.

A Highly Improved Method For Sensitive Determination Of Amitriptyline In Pharmaceutical Formulations Using An Unmodified Carbon Nanotube Electrode In The Presence Of Sulfuric Acid.

The present paper describes a novel, simple and reliable differential pulse voltammetric method for determining amitriptyline (AMT) in pharmaceutical formulations. It has been described for many authors that this antidepressant is electrochemically inactive at carbon electrodes. However, the procedure proposed herein consisted in electrochemically oxidizing AMT at an unmodified carbon nanotube paste electrode in the presence of 0.1 mol L(-1) sulfuric acid used as electrolyte. At such concentration, the acid facilitated the AMT electroxidation through one-electron transfer at 1.33 V vs. Ag/AgCl, as observed by the augmentation of peak current. Concerning optimized conditions (modulation time 5 ms, scan rate 90 mV s(-1), and pulse amplitude 120 mV) a linear calibration curve was constructed in the range of 0.0-30.0 μmol L(-1), with a correlation coefficient of 0.9991 and a limit of detection of 1.61 μmol L(-1). The procedure was successfully validated for intra- and inter-day precision and accuracy. Moreover, its feasibility was assessed through analysis of commercial pharmaceutical formulations and it has been compared to the UV-vis spectrophotometric method used as standard analytical technique recommended by the Brazilian Pharmacopoeia.

Low-density Lipoprotein Cholesterol And Radiotherapy-induced Carotid Atherosclerosis In Subjects With Head And Neck Cancer.

Radiotherapy (RT) is a risk factor for accelerated carotid artery atherosclerotic disease in subjects with head and neck cancer. However, the risk factors of RT-induced carotid artery remodeling are not established. This study aimed to investigate the effects of RT on carotid and popliteal arteries in subjects with head and neck cancer and to evaluate the relationship between baseline clinical and laboratory features and the progression of RT-induced atherosclerosis. Eleven men (age = 57.9 ± 6.2years) with head and neck cancer who underwent cervical bilateral irradiation were prospectively examined by clinical and laboratory analysis and by carotid and popliteal ultrasound before and after treatment (mean interval between the end of RT and the post-RT assessment = 181 ± 47 days). No studied subject used hypocholesterolemic medications. Significant increases in carotid intima-media thickness (IMT) (0.95 ± 0.08 vs. 0.87 ± 0.05 mm; p < 0.0001) and carotid IMT/diameter ratio (0.138 ± 0.013 vs. 0.129 ± 0.014; p = 0.001) were observed after RT, while no changes in popliteal structural features were detected. In addition, baseline low-density lipoprotein cholesterol levels showed a direct correlation with RT-induced carotid IMT change (r = 0.66; p = 0.027), while no other studied variable exhibited a significant relationship with carotid IMT change. These results indicate that RT-induced atherosclerosis is limited to the irradiated area and also suggest that it may be predicted by low-density lipoprotein cholesterol levels in subjects with head and neck cancer.

Treadmill Training Increases Sirt-1 And Pgc-1 α Protein Levels And Ampk Phosphorylation In Quadriceps Of Middle-aged Rats In An Intensity-dependent Manner.

The present study investigated the effects of running at 0.8 or 1.2 km/h on inflammatory proteins (i.e., protein levels of TNF- α , IL-1 β , and NF- κ B) and metabolic proteins (i.e., protein levels of SIRT-1 and PGC-1 α , and AMPK phosphorylation) in quadriceps of rats. Male Wistar rats at 3 (young) and 18 months (middle-aged rats) of age were divided into nonexercised (NE) and exercised at 0.8 or 1.2 km/h. The rats were trained on treadmill, 50 min per day, 5 days per week, during 8 weeks. Forty-eight hours after the last training session, muscles were removed, homogenized, and analyzed using biochemical and western blot techniques. Our results showed that: (a) running at 0.8 km/h decreased the inflammatory proteins and increased the metabolic proteins compared with NE rats; (b) these responses were lower for the inflammatory proteins and higher for the metabolic proteins in young rats compared with middle-aged rats; (c) running at 1.2 km/h decreased the inflammatory proteins and increased the metabolic proteins compared with 0.8 km/h; (d) these responses were similar between young and middle-aged rats when trained at 1.2 km. In summary, the age-related increases in inflammatory proteins, and the age-related declines in metabolic proteins can be reversed and largely improved by treadmill training.

Hypothalamic S1p/s1pr1 Axis Controls Energy Homeostasis.

Sphingosine 1-phosphate receptor 1 (S1PR1) is a G-protein-coupled receptor for sphingosine-1-phosphate (S1P) that has a role in many physiological and pathophysiological processes. Here we show that the S1P/S1PR1 signalling pathway in hypothalamic neurons regulates energy homeostasis in rodents. We demonstrate that S1PR1 protein is highly enriched in hypothalamic POMC neurons of rats. Intracerebroventricular injections of the bioactive lipid, S1P, reduce food consumption and increase rat energy expenditure through persistent activation of STAT3 and the melanocortin system. Similarly, the selective disruption of hypothalamic S1PR1 increases food intake and reduces the respiratory exchange ratio. We further show that STAT3 controls S1PR1 expression in neurons via a positive feedback mechanism. Interestingly, several models of obesity and cancer anorexia display an imbalance of hypothalamic S1P/S1PR1/STAT3 axis, whereas pharmacological intervention ameliorates these phenotypes. Taken together, our data demonstrate that the neuronal S1P/S1PR1/STAT3 signalling axis plays a critical role in the control of energy homeostasis in rats.

Multitarget Effects Of Quercetin In Leukemia.

This study proposes to investigate quercetin antitumor efficacy in vitro and in vivo, using the P39 cell line as a model. The experimental design comprised leukemic cells or xenografts of P39 cells, treated in vitro or in vivo, respectively, with quercetin; apoptosis, cell-cycle and autophagy activation were then evaluated. Quercetin caused pronounced apoptosis in P39 leukemia cells, followed by Bcl-2, Bcl-xL, Mcl-1 downregulation, Bax upregulation, and mitochondrial translocation, triggering cytochrome c release and caspases activation. Quercetin also induced the expression of FasL protein. Furthermore, our results demonstrated an antioxidant activity of quercetin. Quercetin treatment resulted in an increased cell arrest in G1 phase of the cell cycle, with pronounced decrease in CDK2, CDK6, cyclin D, cyclin E, and cyclin A proteins, decreased Rb phosphorylation and increased p21 and p27 expression. Quercetin induced autophagosome formation in the P39 cell line. Autophagy inhibition induced by quercetin with chloroquine triggered apoptosis but did not alter quercetin modulation in the G1 phase. P39 cell treatment with a combination of quercetin and selective inhibitors of ERK1/2 and/or JNK (PD184352 or SP600125, respectively), significantly decreased cells in G1 phase, this treatment, however, did not change the apoptotic cell number. Furthermore, in vivo administration of quercetin significantly reduced tumor volume in P39 xenografts and confirmed in vitro results regarding apoptosis, autophagy, and cell-cycle arrest. The antitumor activity of quercetin both in vitro and in vivo revealed in this study, point to quercetin as an attractive antitumor agent for hematologic malignancies.

Acute Exercise Decreases Trb3 Protein Levels In The Hypothalamus Of Obese Rats.

To evaluate the effects of acute exercise on the TRB3 protein levels and interaction between TRB3/Akt proteins in the hypothalamus of obese rats. In addition, we evaluated the relationship between TRB3 and endoplasmic reticulum stress (ER stress) and verified whether an acute exercise session is able to influence these processes. In the first part of the study, the rats were divided into three groups: control (lean) - fed with a standard rodent chow, DIO - fed with a high fat diet and DIO submitted to a swimming acute exercise protocol (DIO-EXE). In the second part of the study, we used other three groups: control (lean) receiving an intracerebroventricular (i.c.v.) infusion of vehicle, lean receiving an i.c.v. infusion of thapsigargin, and lean receiving an i.c.v infusion of thapsigargin and performing an acute exercise session. Four hours after the exercise session, the food intake was measured and the hypothalamus was dissected and separated for subsequent protein analysis by immunoblotting and Real Time PCR. The acute exercise session reduced the TRB3 protein levels, disrupted the interaction between TRB3/Akt proteins, increased the phosphorylation of Foxo1 and restored the anorexigenic effects of insulin in the hypothalamus of DIO rats. Interestingly, the suppressive effects of acute exercise on TRB3 protein levels may be related, at least in part, to the decrease of ER stress (evaluated though pancreatic ER kinase phosphorylation - pPERK and C/EBP homologous protein - CHOP protein levels) in the hypothalamus. In conclusion, the reduction of hypothalamic TRB3 protein levels mediated by exercise may be associated with the reduction of ER stress. These data provided a new mechanism by which an acute exercise session improves insulin sensitivity in hypothalamus and restores food intake control in obesity.

Inhibition Of Tumor Necrosis Factor-alpha And Cyclooxigenase-2 By Isatin: A Molecular Mechanism Of Protection Against Tnbs-induced Colitis In Rats.

Isatin, an indole alkaloid has been shown to have anti-microbial, anti-tumor and anti-inflammatory effects. Due to its findings, we evaluated whether this alkaloid would have any effect on TNBS-induced colitis. Animals (male Unib:WH rats, aged 8 weeks old) were induced colitis through a rectal administration of 2,4,6-trinitrobenzene sulphonic acid using a catheter inserted 8 cm into the rectum of the animals. The rats were divided into two major groups: non-colitic and colitic. The colitic group was sub-divided into 6 groups (10 animals per group): colitic non-treated, Isatin 3; 6; 12.5; 18.75 and 25 mg/kg. Our main results showed that the oral treatment with Isatin 6 and 25 mg/kg were capable of avoiding the increase in TNF-α, COX-2 and PGE₂ levels when compared to the colitic non-treated group. Interestingly, the same doses (6 and 25 mg/kg) were also capable of preventing the decrease in IL-10 levels comparing with the colitic non-treated group. The levels of MPO, (an indirect indicator of neutrophil presence), were also maintained lower than those of the colitic non-treated group. Isatin also prevented the decrease of SOD activity and increase of GSH-Px and GSH-Rd activity as well as the depletion of GSH levels. In conclusion, both pre-treatments (6 and 25 mg/kg) were capable of protecting the gut mucosa against the injury caused by TNBS, through the combination of antioxidant and anti-inflammatory properties, which, together, showed a protective activity of the indole alkaloid Isatin.