Seaweeds as Nutraceutical Elements and Drugs for Diabetes Mellitus: Future Perspectives.

Diabetes mellitus is a chronic metabolic condition marked by high blood glucose levels caused by inadequate insulin synthesis or poor insulin use. This condition affects millions of individuals worldwide and is linked to a variety of consequences, including cardiovascular disease, neuropathy, nephropathy, and retinopathy. Diabetes therapy now focuses on controlling blood glucose levels through lifestyle changes, oral medicines, and insulin injections. However, these therapies have limits and may not successfully prevent or treat diabetic problems. Several marine-derived chemicals have previously demonstrated promising findings as possible antidiabetic medicines in preclinical investigations. Peptides, polyphenols, and polysaccharides extracted from seaweeds, sponges, and other marine species are among them. As a result, marine natural products have the potential to be a rich source of innovative multitargeted medications for diabetes prevention and treatment, as well as associated complications. Future research should focus on the chemical variety of marine creatures as well as the mechanisms of action of marine-derived chemicals in order to find new antidiabetic medicines and maximize their therapeutic potential. Based on preclinical investigations, this review focuses on the next step for seaweed applications as potential multitargeted medicines for diabetes, highlighting the bioactivities of seaweeds in the prevention and treatment of this illness.

From Ocean to Medicine: Harnessing Seaweed's Potential for Drug Development.

Seaweed, a miscellaneous group of marine algae, has long been recognized for its rich nutritional composition and bioactive compounds, being considered nutraceutical ingredient. This revision delves into the promising role of seaweed-derived nutrients as a beneficial resource for drug discovery and innovative product development. Seaweeds are abundant sources of essential vitamins, minerals, polysaccharides, polyphenols, and unique secondary metabolites, which reveal a wide range of biological activities. These bioactive compounds possess potential therapeutic properties, making them intriguing candidates for drug leads in various medical applications and pharmaceutical drug development. It explores their pharmacological properties, including antioxidant, anti-inflammatory, antimicrobial, and anticancer activities, shedding light on their potential as therapeutic agents. Moreover, the manuscript provides insights into the development of formulation strategies and delivery systems to enhance the bioavailability and stability of seaweed-derived compounds. The manuscript also discusses the challenges and opportunities associated with the integration of seaweed-based nutrients into the pharmaceutical and nutraceutical industries. Regulatory considerations, sustainability, and scalability of sustainable seaweed sourcing and cultivation methods are addressed, emphasizing the need for a holistic approach in harnessing seaweed's potential. This revision underscores the immense potential of seaweed-derived compounds as a valuable reservoir for drug leads and product development. By bridging the gap between marine biology, pharmacology, and product formulation, this research contributes to the critical advancement of sustainable and innovative solutions in the pharmaceutical and nutraceutical sectors.

Algae Food Products as a Healthcare Solution.

Diseases such as obesity; cardiovascular diseases such as high blood pressure, myocardial infarction and stroke; digestive diseases such as celiac disease; certain types of cancer and osteoporosis are related to food. On the other hand, as the world's population increases, the ability of the current food production system to produce food consistently is at risk. As a result, intensive agriculture has contributed to climate change and a major environmental impact. Research is, therefore, needed to find new sustainable food sources. One of the most promising sources of sustainable food raw materials is macroalgae. Algae are crucial to solving this nutritional deficiency because they are abundant in bioactive substances that have been shown to combat diseases such as hyperglycemia, diabetes, obesity, metabolic disorders, neurodegenerative diseases and cardiovascular diseases. Examples of these substances include polysaccharides such as alginate, fucoidan, agar and carrageenan; proteins such as phycobiliproteins; carotenoids such as ß-carotene and fucoxanthin; phenolic compounds; vitamins and minerals. Seaweed is already considered a nutraceutical food since it has higher protein values than legumes and soy and is, therefore, becoming increasingly common. On the other hand, compounds such as polysaccharides extracted from seaweed are already used in the food industry as thickening agents and stabilizers to improve the quality of the final product and to extend its shelf life; they have also demonstrated antidiabetic effects. Among the other bioactive compounds present in macroalgae, phenolic compounds, pigments, carotenoids and fatty acids stand out due to their different bioactive properties, such as antidiabetics, antimicrobials and antioxidants, which are important in the treatment or control of diseases such as diabetes, cholesterol, hyperglycemia and cardiovascular diseases. That said, there have already been some studies in which macroalgae (red, green and brown) have been incorporated into certain foods, but studies on gluten-free products are still scarce, as only the potential use of macroalgae for this type of product is considered. Considering the aforementioned issues, this review aims to analyze how macroalgae can be incorporated into foods or used as a food supplement, as well as to describe the bioactive compounds they contain, which have beneficial properties for human health. In this way, the potential of macroalgae-based products in eminent diseases, such as celiac disease, or in more common diseases, such as diabetes and cholesterol complications, can be seen.

Therapeutic Potential of Polyphenols and Other Micronutrients of Marine Origin.

Polyphenols are compounds found in various plants and foods, known for their antioxidant and anti-inflammatory properties. Recently, researchers have been exploring the therapeutic potential of marine polyphenols and other minor nutrients that are found in algae, fish and crustaceans. These compounds have unique chemical structures and exhibit diverse biological properties, including anti-inflammatory, antioxidant, antimicrobial and antitumor action. Due to these properties, marine polyphenols are being investigated as possible therapeutic agents for the treatment of a wide variety of conditions, such as cardiovascular disease, diabetes, neurodegenerative diseases and cancer. This review focuses on the therapeutic potential of marine polyphenols and their applications in human health, and also, in marine phenolic classes, the extraction methods, purification techniques and future applications of marine phenolic compounds.

Fillet Fish Fortified with Algal Extracts of Codium tomentosum and Actinotrichia fragilis, as a Potential Antibacterial and Antioxidant Food Supplement.

With respect to the potential natural resources in the marine environment, marine macroalgae or seaweeds are recognized to have health impacts. Two marine algae that are found in the Red Sea, Codium tomentosum (Green algae) and Actinotrichia fragilis (Red algae), were collected. Antibacterial and antioxidant activities of aqueous extracts of these algae were evaluated in vitro. Polyphenols from the extracts were determined using HPLC. Fillet fish was fortified with these algal extracts in an attempt to improve its nutritional value, and sensory evaluation was performed. The antibacterial effect of C. tomentosum extract was found to be superior to that of A. fragilis extract. Total phenolic contents of C. tomentosum and A. fragilis aqueous extract were 32.28 ± 1.63 mg/g and 19.96 ± 1.28 mg/g, respectively, while total flavonoid contents were 4.54 ± 1.48 mg/g and 3.86 ± 1.02 mg/g, respectively. Extract of C. tomentosum demonstrates the highest antioxidant activity, with an IC50 value of 75.32 ± 0.07 µg/mL. The IC50 of L-ascorbic acid as a positive control was 22.71 ± 0.03 µg/mL. The IC50 values for inhibiting proliferation on normal PBMC cells were 33.7 ± 1.02 µg/mL and 51.0 ± 1.14 µg/mL for C. tomentosum and A. fragilis, respectively. The results indicated that both algal aqueous extracts were safe, with low toxicity to normal cells. Interestingly, fillet fish fortified with C. tomentosum extract demonstrated the greatest overall acceptance score. These findings highlight the potential of these seaweed species for cultivation as a sustainable and safe source of therapeutic compounds for treating human and fish diseases, as well as effective food supplements and preservatives instead of chemical ones after performing in vivo assays.

Call the Eckols: Present and Future Potential Cancer Therapies.

In recent years, an increased interest in marine macroalgae bioactive compounds has been recorded due to their benefits to human health and welfare. Several of their bioactivities have been demonstrated, such as anti-inflammatory, antioxidant, anticarcinogenic, antibacterial and antiviral behavior. However, there still lacks a clear definition regarding how these compounds exert their bioactive properties. Of all the bioactive compounds derived from marine macroalgae, attention has been focused on phenolic compounds, specifically in phlorotannins, due to their potential for biomedical applications. Phlorotannins are a diverse and wide group of phenolic compounds, with several structural variations based on the monomer phloroglucinol. Among the diverse phlorotannin structures, the eckol-family of phlorotannins demonstrates remarkable bioactivity, notably their anti-tumoral properties. However, the molecular mechanisms by which this activity is achieved remain elusive and sparse. This review focuses on the described molecular mechanisms of anti-tumoral effects by the eckol family of compounds and the future prospects of these molecules for potential application in oncology therapies.

Antidiabetic and antioxidant activity of phlorotannins extracted from the brown seaweed Cystoseira compressa in streptozotocin-induced diabetic rats.

Diabetes mellitus is considered a set of diseases that lead to high glucose level due to the absolute or relative absence of insulin. The study investigated the antioxidant activity and antidiabetic effect of phlorotannins extracted from brown seaweed Cystoseira compressa. Phlorotannins were extracted from C. compressa. It was confirmed by 2,4 dimethoxy benzaldehyde assay (DMBA), ultraviolet spectra, Fourier transform infrared spectroscopy, and ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). The free radical scavenging activity of phlorotannins was estimated by total antioxidant capacity, 1,1-diphenyl-2-picrylhydrazyl radical-scavenging activity, and 2,2 azino-bis3-ethylbenthiazoline-6-sulfonic acid assays. Four groups of albino rats used in this study include control normal, control phlorotannins extract, diabetic by intraperitoneally administering of streptozotocin, and diabetic treatment with 60 mg/kg of phlorotannin extract after 4 weeks of diabetes induction. The main compound identified by UPLC-MS/MS in C. compressa extract belonged to the fuhalol. C. compressa extract showed high antioxidant properties. Phlorotannins significantly decreased serum glucose, liver malondialdehyde, and α-amylase, glucosidase activities. However, total antioxidant capacity, serum insulin, hepatic glutathione, and AMPKα2 expression in skeletal muscle were improved compared to the diabetic group. The histopathological examination showed that phlorotannins markedly reduced damage in ß cells of pancreases. Phlorotannins from C. compressa have efficient antioxidant activity and the antidiabetic effect that may be utilized in human health.

Seaweed Phenolics: From Extraction to Applications.

Seaweeds have attracted high interest in recent years due to their chemical and bioactive properties to find new molecules with valuable applications for humankind. Phenolic compounds are the group of metabolites with the most structural variation and the highest content in seaweeds. The most researched seaweed polyphenol class is the phlorotannins, which are specifically synthesized by brown seaweeds, but there are other polyphenolic compounds, such as bromophenols, flavonoids, phenolic terpenoids, and mycosporine-like amino acids. The compounds already discovered and characterized demonstrate a full range of bioactivities and potential future applications in various industrial sectors. This review focuses on the extraction, purification, and future applications of seaweed phenolic compounds based on the bioactive properties described in the literature. It also intends to provide a comprehensive insight into the phenolic compounds in seaweed.

Antitumour Potential of Gigartina pistillata Carrageenans against Colorectal Cancer Stem Cell-Enriched Tumourspheres.

Gigartina pistillata is a red seaweed common in Figueira da Foz, Portugal. Here, the antitumour potential of G. pistillata carrageenan, with a known variable of the life cycle, the female gametophyte (FG) and tetrasporophyte (T) was evaluated against colorectal cancer stem cell (CSC) -enriched tumourspheres. FTIR-ATR analysis of G. pistillata carrageenan extracts indicated differences between life cycle phases, being FG a κ/ι hybrid carrageenan and T a ʎ/ξ hybrid. Both carrageenan extracts presented IC50 values inferior to 1 µg/mL in HT29-derived CSC-enriched tumourspheres, as well as reduced tumoursphere area. The two extracts were also effective at reducing cellular viability in SW620- and SW480-derived tumourspheres. These results indicate that carrageenans extracted from two G. pistillata life cycle phases have antitumour potential against colorectal cancer stem-like cells, specially the T carrageenan.

Immunological Identification of Fungal Species.

Immunodetection is described in this chapter as a technique for producing specific antibodies for antigen detection of the major human fungal pathogens. In the case of Candida spp., heat-killed cells are used to immunize mice over a couple of weeks and then splenocytes are isolated and further fused with myelomas to easily propagate the antibodies produced in the mice. The resulting antibodies follow a purification process where antibody levels and concentrations are determined. Fungal cells are also lysed to obtain whole cell extracts as a prior step for identification of antigens using immunoprecipitation. Finally, this method permits the production of specific antibodies against fungi and the identification of the respective antigens in an in vivo model.

The CgHaa1-Regulon Mediates Response and Tolerance to Acetic Acid Stress in the Human Pathogen Candida glabrata.

To thrive in the acidic vaginal tract, Candida glabrata has to cope with high concentrations of acetic acid. The mechanisms underlying C. glabrata tolerance to acetic acid at low pH remain largely uncharacterized. In this work, the essential role of the CgHaa1 transcription factor (encoded by ORF CAGL0L09339g) in the response and tolerance of C. glabrata to acetic acid is demonstrated. Transcriptomic analysis showed that CgHaa1 regulates, directly or indirectly, the expression of about 75% of the genes activated under acetic acid stress. CgHaa1-activated targets are involved in multiple physiological functions including membrane transport, metabolism of carbohydrates and amino acids, regulation of the activity of the plasma membrane H+-ATPase, and adhesion. Under acetic acid stress, CgHaa1 increased the activity and the expression of the CgPma1 proton pump and contributed to increased colonization of vaginal epithelial cells by C. glabrata CgHAA1, and two identified CgHaa1-activated targets, CgTPO3 and CgHSP30, are herein demonstrated to be determinants of C. glabrata tolerance to acetic acid. The protective effect of CgTpo3 and of CgHaa1 was linked to a role of these proteins in reducing the accumulation of acetic acid inside C. glabrata cells. In response to acetic acid stress, marked differences were found in the regulons controlled by CgHaa1 and by its S. cerevisiae ScHaa1 ortholog, demonstrating a clear divergent evolution of the two regulatory networks. The results gathered in this study significantly advance the understanding of the molecular mechanisms underlying the success of C. glabrata as a vaginal colonizer.

Effect of progesterone on Candida albicans vaginal pathogenicity.

Candida albicans is responsible for the majority of cases of vulvovaginal candidiasis (VVC), an infection which occurs mainly during the luteal phase of the menstrual cycle or during the pregnancy, when levels of progesterone are elevated. One of the most important candidal virulence factors is the ability to adhere to host surfaces and form biofilms. The aim of this study was to determine the influence of progesterone on C. albicans virulence, namely biofilm formation and colonisation/invasion of a reconstituted human vaginal epithelium (RHVE). Biofilm formation on the RHVE was evaluated by enumeration of culturable cells, total mass quantification and scanning electron microscopy. The capacity of C. albicans strains to invade and colonise the tissue was examined by fluorescence microscopy using species-specific peptide nucleic acid (PNA) probe hybridisation, and quantitatively evaluated by RT-PCR Candida quantification methodology. Furthermore, gene (BCR1 and HWP1) expression of biofilm and RHVE-colonising cells was evaluated by quantitative RT-PCR. Results confirmed that progesterone reduced the capacity of C. albicans strains to form biofilms and to colonise and invade RHVE. Additionally, it was demonstrated that progesterone decreased expression of BCR1 and HWP1, which are important virulence determinants of C. albicans. In conclusion, it was evident that progesterone can have a major influence on C. albicans pathogenicity on vaginal epithelial cells and may partly explain susceptibility of women to VVC at different stages of the menstrual cycle.

Population studies and carrageenan properties in eight Gigartinales (Rhodophyta) from Western Coast of Portugal.

Eight carrageenophytes, representing seven genera and three families of Gigartinales (Florideophyceae), were studied for 15 months. The reproductive status, dry weight, and carrageenan content have been followed by a monthly random sampling. The highest carrageenan yields were found in Chondracanthus acicularis (61.1%), Gigartina pistillata (59.7%), and Chondracanthus teedei var. lusitanicus (58.0%). Species of Cystocloniaceae family produces predominantly iota-carrageenans; Gigartinaceae family produces hybrid kappa-iota carrageenans (gametophytic plants) and lambda-family carrageenans (sporophytic plants); Phyllophoraceae family produces kappa-iota-hybrid carrageenans. Quadrate destructive sampling method was used to determine the biomass and line transect. Quadrate nondestructive sampling method, applied along a perpendicular transect to the shoreline, was used to calculate the carrageenophytes cover in two periods: autumn/winter and spring/summer. The highest cover and biomass were found in Chondrus crispus (3.75%-570 g/m(2)), Chondracanthus acicularis (3.45%-99 g/m(2)), Chondracanthus teedei var. lusitanicus (2.45%-207.5 g/m(2)), and Mastocarpus stellatus (2.02%-520 g/m(2)).

Anesthesia in a patient with multiple endocrine abnormalities: case report / Anestesia para paciente portadora de múltiplas afecções endócrinas: relato de caso / Anestesia para paciente portadora de múltiples afecciones endocrinas: relato de caso

JUSTIFICATIVA E OBJETIVOS: O insulinoma é o tumor endócrino pancreático mais comum. Pode estar associado a neoplasias endócrinas múltiplas (NEM). Relatou-se o caso de paciente com distúrbios endócrinos múltiplos que, no entanto, não se enquadram em síndromes (NEM) já conhecidas e com particularidades clínico-anestésicas que influenciaram no manuseio de sua anestesia. RELATO DO CASO: Paciente feminina, 23 anos, apresentando hipoglicemias de difícil controle associadas à doença de Cushing e prolactinoma, sem sintomas compressivos hipofisários e com estudos de tireóide e de paratireóides sem alterações. A investigação laboratorial encontrou massa retroperitoneal de etiologia desconhecida que, relacionada à situação clínica, levou a hipótese de insulinoma. Relatava ainda ser testemunha de Jeová. A proposta terapêutica era biópsia da massa por videolaparoscopia e enucleação do insulinoma. Ao exame: obesa, dentes protrusos, Mallampati 3 e sintomas de apnéia obstrutiva do sono. Nos exames laboratoriais, o resultado relevante foi o hematócrito de 58 por cento. Recebeu midazolam (7,5 mg) e clonidina (200 µg) via oral como medicação pré-anestésica. A indução anestésica foi realizada com fentanil (150 µg), clonidina (90 µg), propofol (150 mg) e pancurônio (8 mg), sendo realizada a intubação traqueal sem problemas. Foram estabelecidos acesso venoso central e monitoração invasiva da pressão. Mantida infusão de glicose 5 por cento com eletrólitos e monitorada a glicemia capilar a cada 30 minutos, que não acusou episódios de hipoglicemia durante a intervenção cirúrgica. Manteve-se hemodinamicamente estável mesmo durante o pneumoperitônio. No pós-operatório apresentou episódios de hipoglicemia que motivaram sua reoperação. CONCLUSÕES: A singularidade do caso está na conjunção de múltiplas endocrinopatias e de particularidades do manuseio cirúrgico-anestésico. A exérese do insulinoma deve ser monitorada no intra-operatório para que se evitem ressecções ...

BACKGROUND AND OBJECTIVES: Insulinoma is the most common pancreatic endocrine tumor and it can be associated with multiple endocrine neoplasia (MEN). This is a report on a patient with multiple endocrine abnormalities, who did not fulfill the criteria of known syndromes (MEN) and the clinical-anesthetic particularities that influenced the anesthetic management. CASE REPORT: A 23-year old female patient with episodes of hypoglycemia difficult to control, associated with Cushing's disease and prolactinoma without symptoms of pituitary compression and with normal thyroid and parathyroid. Investigation found a retroperitoneal mass of unknown origin which in face of the clinical presentation raised the hypothesis of insulinoma. The patient also referred to be a Jehovah's Witness. Biopsy of the mass by videolaparoscopy and enucleation of the insulinoma were proposed. On physical exam the patient was overweight, had protruding teeth, she was classified as Mallampati 3 and had symptoms of sleep apnea. Laboratorial exams revealed hematocrit 58 percent. Pre-anesthetic medication consisted of oral midazolam (7.5 mg) and clonidine (200 µg). Fentanyl (150 µg), clonidine (90 µg), propofol (150 mg) and pancuronium (8 mg) were used for anesthetic induction and she was intubated without intercurrences. Central venous access and invasive blood monitoring were instituted. Intravenous infusion of D5W with electrolytes was instituted and capillary glucose levels were monitored every 30 minutes, which did not demonstrate any episodes of hypoglycemia during the surgery. The patient remained hemodynamically stable even during the pneumoperitoneum. She developed postoperative episodes of hypoglycemia, which motivated the re-operation. CONCLUSIONS: This case is unique due to the presence of multiple endocrine abnormalities and the particularities of the surgical-anesthetic management. Intraoperative monitoring is mandatory during removal of an insulinoma to avoid ...

JUSTIFICATIVA Y OBJETIVOS: El insulinoma es un tumor endocrino pancreático más común. Pude estar asociado a neoplasias endocrinas múltiples (NEM). Se ha relatado el caso de paciente con disturbios endocrinos múltiplos que, sin embargo, no se encuadra en síndromes (NEM) ya conocidas, y con particularidades clínico anestésicas que influyeron en el manejo de su anestesia. RELATO DEL CASO: Paciente femenina, 23 años, con hipoglicemias de difícil control asociadas a la enfermedad de Cushing y prolactinoma, sin síntomas compresivos hipofisarios, y con estudios de tiroides y de paratiroides sin alteraciones. La investigación laboratorial encontró masa retroperitoneal de etiología desconocida que, relacionada con la situación clínica, conllevó a la hipótesis de insulinoma. Decía que era testigo de Jeová. La propuesta terapéutica era biopsia de la masa por videolaparoscopía y enucleación del insulinoma. Cuando se le hizo el examen, se le encontró obesa, con dientes protuberantes, Mallampati 3 y síntomas de apnea obstructiva del sueño. En los exámenes laboratoriales, el resultado relevante fue el hematócrito de 58 por ciento. Recibió midazolan (7,5 mg) y clonidina (200 µg) vía oral, como medicación preanestésica. La inducción anestésica fue realizada con fentanil (150 µg), clonidina (90 µg), propofol (150 µg) y pancuronio (8 mg), siendo realizada la intubación traqueal sin problemas. Se establecieron el acceso venoso central y el monitoreo invasivo de la presión. Se mantuvo infusión de glicosis al 5 por ciento con electrolitos y se monitoreó la glicemia capilar a cada 30 minutos, que no mostró episodios de hipoglicemia durante la operación. Se mantuvo hemodinámicamente estable incluso durante el neumoperitoneo. En el postoperatorio presentó episodios de hipoglicemia, que motivaron su reoperación. CONCLUSIONES: La singularidad del caso está en la conjunción de las múltiples endocrinopatías y de particularidades del manoseo quirúrgico-anestésico. ...

Anesthesia in a patient with multiple endocrine abnormalities. Case report.

BACKGROUND AND OBJECTIVES: Insulinoma is the most common pancreatic endocrine tumor and it can be associated with multiple endocrine neoplasia (MEN). This is a report on a patient with multiple endocrine abnormalities, who did not fulfill the criteria of known syndromes (MEN) and the clinical-anesthetic particularities that influenced the anesthetic management. CASE REPORT A 23-year old female patient with episodes of hypoglycemia difficult to control, associated with Cushing's disease and prolactinoma without symptoms of pituitary compression and with normal thyroid and parathyroid. Investigation found a retroperitoneal mass of unknown origin which in face of the clinical presentation raised the hypothesis of insulinoma. The patient also referred to be a Jehovah's Witness. Biopsy of the mass by video-laparoscopy and enucleation of the insulinoma were proposed. On physical exam the patient was overweight, had protruding teeth, she was classified as Mallampati 3 and had symptoms of sleep apnea. Laboratorial exams revealed hematocrit 58%. Pre-anesthetic medication consisted of oral midazolam (7.5 mg) and clonidine (200 microg). Fentanyl (150 microg), clonidine (90 microg), propofol (150 mg) and pancuronium (8 mg) were used for anesthetic induction and she was intubated without intercurrences. Central venous access and invasive blood monitoring were instituted. Intravenous infusion of D5W with electrolytes was instituted and capillary glucose levels were monitored every 30 minutes, which did not demonstrate any episodes of hypoglycemia during the surgery. The patient remained hemodynamically stable even during the pneumoperitoneum. She developed postoperative episodes of hypoglycemia, which motivated the re-operation. CONCLUSIONS: This case is unique due to the presence of multiple endocrine abnormalities and the particularities of the surgical-anesthetic management. Intraoperative monitoring is mandatory during removal of an insulinoma to avoid incomplete tumor resection. Multiple challenges in one patient demand the knowledge, by the anesthesiologist, of each obstacle and its interactions in order to devise strategies to control them.

Estudo prospectivo das repercussões de baixas doses de remifentanil na função sinoatrial e na condução e refratariedade cardíaca / Prospective study on the repercussions of low doses of remifentanil on sinoatrial function and in cardiac conduction and refractory period

JUSTIFICATIVA E OBJETIVOS: O remifentanil é um opióide com início e término de ação rápidos, cujo uso em procedimentos de curta duração vem se propagando nos últimos anos. Entre os efeitos colaterais descritos, há relatos de bradicardia e assistolia. O objetivo deste estudo foi avaliar os efeitos desse fármaco na condução e refratariedade cardíaca, em humanos. MÉTODO: Estudo prospectivo de 16 pacientes, entre 18 e 65 anos, de ambos os sexos, ASA I a III, submetidos a estudo eletrofisiológico intracardíaco eletivo. Foram excluídos os pacientes com doença do nódulo sinoatrial e os portadores de bloqueios cardíacos graves. No laboratório de eletrofisiologia, os pacientes foram inicialmente sedados com midazolam (0,03 mg.kg-1), após 5 minutos (M0) avaliou-se o grau de sedação de intensidade de dor, pressões arteriais sistólica e diastólica, freqüências cardíaca e respiratória e saturação de oxigênio. O eletrofisiologista avaliou as variáveis de condução cardíaca (duração do QRS, intervalos AA, AH, HV e PA), o tempo de recuperação do nódulo sinoatrial e as variáveis de refratariedade cardíaca (período refratário do átrio direito, período refratário do ventrículo direito e período refratário do nódulo atrioventricular). Após as medidas iniciais o remifentanil foi introduzido (bolus de 0,5 μg.kg-1 + infusão de 0,05 μg.kg-1.min-1) e após 20 minutos as mesmas variáveis foram reavaliadas (M1). RESULTADOS: Observou-se diminuição das pressões sistólica e diastólica (p = 0,0001) entre M0 e M1, sem diferença estatística significativa da freqüência respiratória ou da saturação de oxigênio. Houve aumento do intervalo átrio-His (p = 0,006) e do tempo de recuperação do nódulo sinoatrial (p = 0,0004), do período refratário do átrio direito (p = 0,001) e do período refratário do nódulo atrioventricular (p = 0,0001), porém não houve diminuição da freqüência cardíaca basal entre M0 e M1. CONCLUSÕES: O remifentanil alterou as variáveis eletrofisiológicas cardíacas,...

BACKGROUND AND OBJECTIVES: Remifentanil is an opiod with fast onset of action and short acting, and its use in short-duration procedures has increased in the last few years. Bradycardia and asystole are among the side effects reported. The objective of this study was to evaluate the effects of this drug in cardiac conduction and refractory period in human beings. METHODS: A prospective study with 16 patients, ages 18 to 65, both genders, ASA I to III, undergoing elective intracardiac electrophysiological study, was undertaken. Patients with disorders of the sinoatrial node and those with severe cardiac blocks were excluded. In the laboratory of electrophysiology, patients were sedated with midazolam (0.03 mg.kg-1) after 5 minutes the degree of sedation and degree of pain, systolic and diastolic blood pressure, heart rate and respiratory rate, and oxygen saturation were evaluated. The electrophysiologist evaluated cardiac conduction (duration of the QRS complex, and AA, AH, HV, and PA intervals), duration of sinoatrial node recovery, and cardiac refractory period (refractory period of the right atrium, right ventricle, and atrioventricular node). After the initial measurements, remifentanil was administered (bolus of 0.5 μg.kg-1 + infusion of 0.05 μg.kg-1.min-1) and, after 20 minutes, the same parameters were evaluated. RESULTS: There was a reduction in systolic and diastolic blood pressure (p = 0.0001) between M0 and M1, and significant differences in respiratory rate and oxygen saturation, which were not statistically significant. The atrium-His interval (p = 0.006), recovery time of the sinoatrial node (p = 0.0004), refractory period of the right atrium (p = 0.001), and refractory period of the sinoatrial node (p = 0.0001) were all increased; however, there were no differences in heart rate between M0 and M1. CONCLUSIONS: Remifentanil changes cardiac electrophysiological parameters and, in doses higher than the ones used in this study,...

JUSTIFICATIVA Y OBJETIVOS: El remifentanil es un opioide con inicio y fin de acción rápidos, cuyo uso en procedimientos de corta duración se ha venido propagando en los últimos años. Entre los efectos colaterales descritos, hay relatos de bradicardia y asistolia. El objetivo de este estudio fue evaluar los efectos de este fármaco en la conducción y refractariedad cardíaca, en humanos. MÉTODO: Estudio prospectivo de 16 pacientes, entre 18 y 65 años, de ambos sexos, ASA I a III, que se sometieron a estudio electrofisiológico intra cardiaco electivo. Se excluyeron pacientes con enfermedades del nódulo sino-atrial y los portadores de bloqueos cardíacos graves. En el laboratorio de electrofisiologia, los pacientes fueron inicialmente sedados con midazolam (0,03 mg.kg-1), 5 minutos después (M0) se evaluó el grado de sedación e intensidad de dolor, presiones arteriales sistólica y diastólica, frecuencias cardíaca y respiratoria y saturación de oxígeno. El electrofisiologista evaluó las variables de conducción cardíaca (duración del QRS, intervalos AA, AH, HV y PA), el tiempo de recuperación del nódulo sino-atrial y las variables de refractariedad cardíaca (período refractario del atrio derecho, período refractario del ventrículo derecho y período refractario del nódulo atrio ventricular). Después de las medidas iniciales el remifentanil fue introducido (bolo de 0,5 μg.kg-1 + infusión de 0,05 μg.kg-1.min-1) y después de 20 minutos las mismas variables fueron evaluadas nuevamente (M1). RESULTADOS: Se observó disminución de las presiones sistólica y diastólica (p = 0.0001) entre M0 y M1, sin diferencia estadística significativa de la frecuencia respiratoria o de la saturación de oxígeno. Hubo aumento del intervalo atrio-His (p = 0,006) y del tiempo de recuperación del nódulo sino-atrial (p = 0,0004), del período refractario del atrio derecho (p = 0,001) y del período refractario del nódulo atrio ventricular (p = 0,0001), pero no hubo disminución...

Modelo de indução de necrose focal hepática: estudo experimental em ratos / Induction model of hepatic focal necrosis: experimental study in rats

OBJETIVO: Investigar a área de necrose focal induzida pela injeção intra-hepática de quatro diferentes substâncias no fígado de ratos. MÉTODOS: Foram utilizados 25 ratos Wistar, com peso variando entre 200 a 250 g, distribuidos em 5 grupos, que receberam 0,1cc das seguintes substâncias: Grupo I (Gr. I) - soro fisiológico a 0,9 por cento (controle). Grupo II (Gr. II) - glicose hipertônica a 50 por cento. Grupo III (Gr. III) - NaCl a 20 por cento. Grupo IV (Gr. IV) - formol a 10 por cento. Grupo V (Gr. V) - etanol. Os animais foram submetidos a laparotomia para que a punção fosse realizada no lobo hepático médio sob visão direta. Todos os animais foram sacrificados após 24 horas da injeção.. Os fígados foram avaliados histologicamente, com o intuito de mensurar a área do tecido necrótico. RESULTADOS: Nos cinco grupos estudados observou-se: Gr. I - 2829mm² (controle); Gr. II - 3805mm² (glicose hipertônica); Gr. III - 3930mm² (NaCl); Gr. IV - 4532mm² (formol) e Gr. V - 6432mm² (etanol). A análise estatística destes valores foi feita pelo método das comparações múltiplas. CONCLUSÃO: 1. O soro fisiológico foi à substância que causou a menor área de necrose (P< 0,05). 2. O NaCl a 20 por cento e a glicose hipertônica a 50 por cento produzem efeitos semelhantes (P > 0,05). 3. O formol a 10 por cento produziu necrose mais extensa que a glicose hipertônica a 50 por cento (P < 0,05) e que o NaCl a 20 por cento, porém não apresentou diferença estatisticamente significativa com esta última (P > 0,05). 4. O etanol foi à substância que, comparada com as outras, mais necrose produziu (P < 0,05).

Mecânica respiratória, morfometria da parede torácica e histologia pulomonar: repercussões das incisões mediana e subcostal bilateral para hepatectomia total em ratos / Respiratory mechanics, morphometry and lung histology: longitudinal laparotomy and bilateral subcostal incision in total hepatectomy in rats

Analisou-se mecânica respiratória, morfometria da parede torácica e histologia pulmonar em ratos na situaçäo controle (C, pré-incisäo), após a incisäo mediana (MED) ou subcostal bilateral (SCB) e depois da hepatectomia. Outros 2 grupos foram operados (mesmas vias) e submetidos apenas a exclusäo vascular de fígado (EVF). Os ratos foram sedados, anestesiados, traqueotomizados, paralizados e ventilados mecanicamente. A mecânica respiratória foi determinada pelo método da oclusäo ao final da inspiraçäo sendo computados para o sistema respiratório (rs), pulmäo (L) e parede torácica (w): elastâncias estática (Est) e dinâmica (Edyn), variaçäoE(Edyn-Est), pressões resistiva (variaçäoP1) e dissipada para vencer os componentes viscoelásticos e/ou inomogêneos (variaçäoP2). variaçäoP1+variaçäoP2=variaçäPot. A mecânica respiratória näo se modificou após EVF. A hepatectomia por via SCB reduziu variaçäoPtost,rs, variaçäoPtot,L, variaçäoP2,rs, variaçäoPs,L, significativamente. A via mediana näo modificou tais parâmetros. Est,L reduziu após a hepatectomia por via SCB e MED. Ambas incisões acarretaram aumento na Est,w, porém variaçäoptot,w, variaçäop1,w e variaçäoP2,w näo evidenciaram alterações em relaçäo a C. A queda de Est,L provêm das alterações morfométricas da parede e do aumento no diâmetro alveolar médio (Lm). Em conclusäo, considerando-se os parâmetros da mecânica respiratória e histologia pulmonar, as modificações decorrentes da hepatectomia por via subcostal bilateral säo mais benéficas do que aquelas por via mediana

Ressecçäo transuretral de próstata com anestesia loco-regional: nota prévia sobre quatro casos / Transurethral resection of the prostate with local anesthesia: previous note on 4 cases

Apresenta-se o uso de anestesia loco-regional na ressecçäo transuretral de próstata. O método foi utilizado em quatro pacientes, onde a infiltraçäo peri e intraprostática (bupivacaína e/ou lidocaína) possibilitou, com o uso concomitante de sedaçäo (benzodiazepínico intravenoso) a ressecçäo transuretral da próstata. Descreve-se a técnica e discute-se a indicaçäo deste procedimento em pacientes com risco cirúrgico elevado por doenças cardiopulmonares. Nos quatro casos, o procedimento mostrou-se eficaz, seguro e bem tolerado pelos pacientes