Informe diário de evidências COVID-19: busca realizada em 16 e 18 de maio de 2020 / COVID-19 daily evidence report: search conducted on May 16 and 18, 2020

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referente ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 22 artigos e 10 protocolos.

Impact of topical nifedipine on wound healing in animal model (pig) / Impacto da nifedipina tópica na cicatrização de feridas em modelo animal (porco)

Abstract Background The human skin is an extremely sophisticated and evolved organ that covers the whole body. External agents or the patient's own diseases can cause skin injuries that can challenge healthcare professionals and impose high social, economic and emotional costs. Objectives To evaluate the impact of topical nifedipine on skin wound healing, specifically on polymorphonuclear cells, vascular proliferation, and collagen. Methods We used three pigs, and created eight injuries in the dorsal region of each animal. We applied 1%, 10%, and 20% concentration nifedipine creams to four of the wounds in animals 1, 2, and 3 respectively and treated the other twelve wounds with saline solution 0.9% only. We analyzed the presence of polymorphonuclear cells, vascular proliferation, and collagen at six different times (days 1, 3, 7, 14, 21, and 28). Results The evaluation of polymorphonuclear levels showed mild cell activity at all times in the control group, while in the nifedipine groups, marked levels were more frequent at all times during the experiment. There was a 4.84-fold increase in the chance of marked vascular proliferation (p = 0.019) and, at the same time, a decrease in collagen formation (OR 0.02 / p = 0.005) in animal 3. Conclusions Topical NFD may have an impact on skin wound healing mechanisms. Our study showed that polymorphonuclear cells and vascular proliferation increased. We also demonstrated that collagen formation decreased. Therefore, topical NFD may have a positive impact on skin wound healing. Additional studies are needed to confirm our results.

Resumo Contexto A pele humana é um órgão extremamente sofisticado e evoluído que cobre todo o corpo. As lesões cutâneas podem ser causadas por agentes externos ou pelas próprias doenças do paciente, e podem representar um desafio para os profissionais de saúde com altos custos sociais, econômicos e emocionais. Objetivos Avaliar o impacto da nifedipina tópica na cicatrização de feridas cutâneas, especialmente em relação a polimorfonucleares, proliferação vascular e colágeno. Métodos Utilizamos três porcos e realizamos oito ferimentos na região dorsal de cada animal. Aplicamos as concentrações de nifedipina creme a 1%, 10% e 20% para os animais 1, 2 e 3, respectivamente, sendo que, em quatro ferimentos, aplicamos o creme e, nos outros quatro ferimentos, apenas soro fisiológico a 0,9%. Analisamos a presença de polimorfonucleares, proliferação vascular e colágeno em seis momentos diferentes (dias 1, 3, 7, 14, 21 e 28). Resultados A avaliação dos níveis polimorfonucleares mostrou atividade celular discreta em todos os momentos no grupo controle, enquanto nos grupos nifedipina, os níveis marcados foram mais frequentes em todos os momentos do experimento. Houve aumento de 4,84 vezes na chance de uma produção marcada (p = 0,019) da proliferação vascular e, ao mesmo tempo, diminuição da formação do colágeno (odds ratio, OR 0,02; p = 0,005) no animal 3. Conclusões A nifedipina tópica pode ter impacto no mecanismo de cicatrização cutânea. Nosso estudo mostrou que há aumento dos polimorfonucleares e da proliferação vascular. Além disso, há diminuição da formação do colágeno. Assim, a nifedipina tópica pode ter impacto positivo na cicatrização das feridas cutâneas. Estudos adicionais são necessários para confirmar nossos resultados.

Vasculopatia livedoide tratada com rivaroxabana / Livedoid vasculopathy treated with rivaroxaban

A vasculopatia livedoide é uma doença rara caracterizada pela oclusão da microvasculatura da derme, originando lesões maculosas que, posteriormente, podem evoluir para úlceras e cicatrizes atróficas. Como um fenômeno vaso-oclusivo, o tratamento geralmente é realizado com antiplaquetários e fibrinolíticos. O presente relato descreve o caso de uma paciente refratária à terapia convencional, que obteve regressão da doença utilizando a rivaroxabana, um fármaco inibidor seletivo do fator Xa. (AU)

Livedoid vasculopathy is a rare disease characterized by occlusion of the dermis microvasculature, leading to spotted lesions that can later develop into ulcers and atrophic scars. As a vaso- occlusive phenomenon, treatment is usually performed with antiplatelet and fibrinolytic agents. The present report describes the case of a female patient refractory to conventional therapy who presented disease remission using rivaroxaban, a selective factor Xa inhibitor drug. (AU)

Doppler de las arterias uterinas, umbilical y cerebral media fetal en embarazada con amenaza de parto pretérmino tratada con nifedipina oral / Doppler of uterine, umbilical and middle cerebral fetal arteries in pregnant women with preterm labor treated with oral nifedipine

Determinar las modificaciones en Doppler de las arterias uterinas, umbilical y cerebral media fetal en embarazadas con amenaza de parto pretérmino tratada con nifedipina oral como tocolítico. Se seleccionaron 50 pacientes con diagnóstico de amenaza de parto pretérmino. Las pacientes recibieron nifedipina a una dosis inicial de 30 mg sublinguales seguida por una dosis oral de 20 mg dos a cuatro veces al día. La dosis máxima fue de 120 mg cada 24 horas. Se midieron los índices de pulsatilidad, índice de resistencia y relación de flujo sistólico / diastólica de las arterias uterinas, umbilical y cerebral media fetal antes y después del tratamiento. Servicio de Ginecología y Obstetricia. Hospital Central "Dr. Urquinaona". Maracaibo, Estado Zulia. La edad materna promedio al inicio del estudio fue de 26,9 ± 6,9 años y la edad gestacional promedio fue de 30,3 ± 2,6 semanas. La duración promedio del tratamiento fue de 4,8 ± 1,5 días. No se encontraron diferencias estadísticamente significativas en los valores promedio de la frecuencia cardíaca materna y fetal, presión arterial sistólica, presión arterial diastólica antes y después del tratamiento con nifedipina oral (P = ns). No se encontraron diferencias significativas en los índices de pulsatilidad, índice de resistencia y relación de flujo sistólico / diastólica en las arterias uterinas, umbilical y cerebral media fetal antes y después del tratamiento con nifedipina oral (P = ns). El uso de nifedipina oral como tocolítico no produce modificaciones significativas en las mediciones Doppler de las arterias uterinas, umbilical y cerebral media fetal en embarazadas con amenaza de parto pretérmino

To determine modifications of Doppler of uterine, umbilical and fetal middle cerebral arteries in pregnant women with threatened pre-term labor treated with oral nifedipine as tocolytic agent. Fifty patients with diagnosis of threatened pre-term labor were selected. Patients received an initial dose of 30 mg of sub lingual nifedipine followed by an oral dose of 20 mg twice to four times a day. A maximum dosage was of 120 mg each 24 hours. The pulsatility index, resistance index and systolic/diastolic blood flow ratio of uterine, umbilical and fetal middle cerebral arteries were measured before treatment and after treatment. Servicio de Ginecologia y Obstetricia. Hospital Central "Dr. Urquinaona". Maracaibo, Estado Zulia. Maternal mean age at beginning of study was 26.9 ± 6.9 years-old and gestational mean age was 30.3 ± 2.6 weeks. Mean duration of treatment was 4.8 ± 1.5 days. There were not found significant differences in mean values of maternal and fetal heart rate, systolic blood pressure and diastolic blood pressure before and after treatment with oral nifedipine (p = ns). There were not found significant differences in pulsatility index, resistance index and systolic/diastolic blood flow ratio of uterine, umbilical and fetal middle cerebral arteries before and after treatment (p = ns). The use of oral nifedipine as tocolytic agent did not produce significant modifications in Doppler measurements of uterine, umbilical and fetal middle cerebral arteries in pregnant women with threatened pre-term labor

Anticonvulsant and antiarrhythmic effects of nifedipine in rats prone to audiogenic seizures

Calcium ion participates in the regulation of neural transmission and the presynaptic release of neurotransmitters. It is also involved in epileptic events, cardiac arrhythmias and abnormal conduction of stimuli. The purpose of the present study was to evaluate the effects of nifedipine, a calcium channel blocker, on epileptic seizures and on reperfusion arrhythmias in rats prone to audiogenic epileptic seizures (Wistar audiogenic rats, WAR) and in normal Wistar rats (N = 6/group). The seizure severity index was applied after an intraperitoneal injection of 20 or 40 mg/kg nifedipine (N20 and N40 groups, respectively). The Langendorff technique was used to analyze cardiac function, as well as the incidence and severity of the reperfusion arrhythmias after ligature and release of the left coronary artery in rats treated or not with nifedipine. We found that nifedipine treatment decreased seizure severity (0.94 ± 0.02 for WAR; 0.70 ± 0.10 for WAR + N20; 0.47 ± 0.08 for WAR + N40) and increased the latent period (13 ± 2 s for WAR; 35 ± 10 s for WAR + N20; 48 ± 7 s for WAR + N40) for the development of seizures in WAR. Furthermore, the incidence and severity of the reperfusion arrhythmias were lower in WAR and normal Wistar rats injected with nifedipine. In WAR, these effects were mediated, at least in part, by a decrease in heart rate. Thus, our results indicate that nifedipine may be considered to be a potential adjuvant drug for epilepsy treatment, especially in those cases associated with cardiac rhythm abnormalities.

Preference of patient information leaflets over standard drug monographs by patients prescribed hydrochlorothiazide, nifedipine and enalapril / Preferencia por los prospectos de información al paciente en lugar de las monografías estándar sobre medicamentos, por parte de los pacientes a quienes se les ha prescrito hidroclorotiazida, nifedipina y analapril

Standard drug monographs (SDMs) have been described as deficient in providing information in a manner simplified enough for patient reading. The aim of this study was to design patient information leaflets for hydrochlorothiazide, nifedipine and enalapril with content indicated by patients as relevant and to evaluate them against the SDM. Patient information leaflet (PIL) for each drug was designed to contain information on name, use of drug, how it works, how it is to be taken, common side effects, storage, missed dose action, things to avoid and when to contact the physician. Appropriateness was assessed by 10 practising pharmacists. For each drug, 40 patients were recruited, of which 20 were given SDM and 20 PIL. The knowledge of each participant was examined before and after exposure to SDM or PIL, as well as opinion on ease of reading and attractiveness using Pearson's Chi-square analysis. The results showed that both SDM and PIL improved knowledge of common side effects when compared with responses before exposure (χ² = 24.26for SDM and 27.64 for PIL, p < 0.001) with no difference between the groups. Respondents receiving PILs were better able to recall "things to avoid" after exposure to PIL (χ² =10.85, p < 0.001). After exposure to SDM or PIL, the respondents who received PIL were more aware of when to contact the physician, compared to the SDM group (χ² = 8.41, p < 0.01). When compared with SDM, respondents receiving PIL were more likely to indicate that PIL was easy to read (χ² = 20.00, p < 0.001), attractive (χ² = 12.45, p < 0.001) and they were more likely to recommend distribution of their reading material to other patients (χ² = 22.11, p < 0.001). We conclude that there is benefit in designing information leaflets that simplify language and medication information contained in SDMs, including better understanding of precautions to take while on medication and when to consult physicians.

Las monografías de medicamentos estandarizadas se han considerado deficientes a la hora de proporcionar información de manera suficientemente simple para que el paciente pueda entenderlas. El objetivo de este estudio fue disenar prospectos con información sobre la hidroclorotiazida, la nifedipina y el analapril con contenidos indicados como relevantes por los pacientes, y evaluarlos en comparación con las monografías estandarizadas de medicamentos (MEM). El prospecto de información para el paciente (PIP) fue disenado de modo que apareciera información sobre el nombre del medicamento, su uso, modo de operar, manera de tomarse, efectos secundarios comunes, almacenamiento, qué hacer en caso de perder una dosis, cosas que deben evitarse, y cuando debe contactarse el médico. Se evaluó la adecuación por parte de 10 farmacéuticos practicantes. Para cada medicamento, se reclutaron 40 pacientes, a 20 de los cuales se les dio monografías (MEM), en tanto que a 20 se les ofreció prospectos (PIP). El conocimiento de cada participante se examinó antes y después de la exposición a MEM o PIP, así como la opinión en cuanto a facilidad de lectura y grado de atracción, usando el análisis del Chi-cuadrado de Pearson. Los resultados mostraron que tanto MEM como PIP mejoraron el conocimiento sobre los efectos secundarios comunes, cuando se hacía una comparación con las respuestas antes de la exposición (χ² = 24.26para MEMy 27.64para PIP, p < 0.001) sin diferencia entre los grupos. Los encuestados que recibieron prospectos pudieron recordar mejor las "cosas a evitar" luego de la exposición a PIP (χ² =10.85, p < 0.001). Después de la exposición a MEM o PIP, los encuestados con PIP tenían mayor conciencia en cuanto a cuando contactar a un médico, en comparación con el grupo MEM (χ² = 8.41, p < 0.01). Cuando se les comparó con el grupo MEM, los encuestados que recibieron PIP mostraron por una parte mayor probabilidad de indicar que PIP era más fácil de leer (χ² = 20.00, p < 0.001) y atractivo (χ² = 12.45, p < 0.001), y por otra, una mayor tendencia a recomendar la distribución de su material de lectura a otros pacientes (χ² = 22.11, p < 0.001). Se llegó a la conclusión de que es beneficioso disenar prospectos que simplifiquen el lenguajey la información médica contenida en las monografias estándar del medicamento, incluyendo una mejor comprensión de las precauciones a tomar mientras se está bajo medicación, y sobre cuándo consultar al médico.

Nifedipina de liberación programada en micro-gránulos para el control de la enfermedad hipertensiva del embarazo / Release nifedipine programmed micro-pellets for the control of hipertensive disease of pregnancy

Determinar la eficacia y efectividad de la utilización de la nifedipina de liberación programada en micro-gránulos en el tratamiento de la enfermedad hipertensiva del embarazo. Se admitieron sesenta y dos pacientes consecutivas con enfermedad hipertensiva del embarazo con edad gestacional mayor de 20 semanas, fueron asignados a recibir 30 o 60 mg de nifedipina de liberación programada en micro-gránulos en la mañana con el punto final de obtener un control eficaz de la presión arterial (presión arterial sistólica ≤ 120 y presión arterial diastólica ≤ 80 mmHg), cuantificada con esfigmomanómetro de mercurio. Casos con historia de insuficiencia cardíaca y que recibían tratamiento antihipertensivo durante el curso del actual embarazo fueron excluidos. Se cuantificó el tiempo requerido para obtener el control eficaz de la presión arterial y se identificaron los episodios de crisis hipertensiva con el tratamiento así como los efectos adversos en la madre o el feto. El promedio de edad de las pacientes fue de 28,2±7,8 años. Peso 75,1±13,2 kg, talla 162,3±7,0 cm. Ídice de masa corporal 28,5 ± 4,6 kg/m2. Las reducciones de las presiones arteriales fueron: decúbito. Presión arterial sistólica (de 140,0±8,1 a 119,0±8,8 mmHg. P < 0,0001), presió arterial diastóica (de 89,7±7,7 a 72,7±7,8 mmHg. P < 0,0001), frecuencia cardíca (de 82,2±10 a 81,3±10 Lat/min. P = 0,31). Sentadas. Presió arterial sistóica (de 140,3±6,8 a 117,9±8,9 mmHg. P < 0,0001), PAD (de 88,6±8,1 a 71,5±8,5 mmHg. P < 0,0001), frecuencia cardíca (de 84,2±9,0 a 82,3±9,4 Lat/min. P = 0,12). De pie. Presió arterial sistóica (de 141,7±6,76 a 118,3±8,5 mmHg. P < 0,0001), presió arterial diastóica (de 88,9±6,9 a 72,6±8,6 mmHg. P < 0,0001), frecuencia cardíca (de 84,8±9,2 a 83,6±9,6 lat/min. P =0,24). El control de las cifras de presió arterial se logróen un promedio de 6 semanas de tratamiento con nifedipina de liberació programada en micro-gránulos. No se produjo nuevos eventos de crisis hipertensiva ni efectos...

Determine the efficacy and effectiveness of the use of programmed liberate nifedipine on microgranules in the treatment of the hypertensive disease in pregnancy. Sixty two serial patients were admitted with hypertensive disease in pregnancy with age gestacional superior than 20 weeks, were they assigned to receive 30 or 60 mg of programmed liberate nifedipine on micro-granules in the morning with the final objective from obtaining an effective control of the blood pressure (systolic blood pressure ≤ 120 and diastolic blood pressure ≤ 80 mmHg), quantified with a mercury sphygmomanometer. Cases with history of heart inadequacy and that they received antihypertensive treatment during the course of the current pregnancy they were excluded. The time required to obtain the effective control of the blood pressure was quantified and the episodes of hypertensive crisis were identified with the treatment as well as the adverse effects in the mother or the fetus. The age of the patients was of 28.2±7.8 years, weigh 75.1±13.2 kilos, height 162.3±7.0 cm, Index of corporal mass 28.5 ± 4.6 kg/m2. The reductions of the arterial pressures were: decubitus. Systolic blood pressure (of 140.0±8.1 at 119.0±8.8 mmHg. P <0.0001), diastolic blood pressure (of 89.7±7.7 at 72.7±7.8 mmHg. P <0.0001), heart rate (of 82.2±10 to 81.3±10 beats/min. P = 0.31). Seated Systolic blood pressure (of 140.3±6.8 at 117.9±8.9 mmHg. P <0.0001), diastolic blood pressure (of 88.6±8.1 at 71.5±8.5 mmHg. P <0.0001), heart rate (of 84.2±9,0 to 82.3±9.4 beats/min. P = 0.12). Of foot. Systolic blood pressure (of 141.7±6.76 at 118.3±8.5 mmHg. P <0.0001), diastolic blood pressure (of 88.9±6.9 at 72.6±8.6 mmHg. P <0.0001), heart rate (of 84.8±9.2 to 83.6±9.6 beats/min. P = 0.24). The blood pressure control was achievement in an average of 6 weeks of treatment with programmed liberate nifedipine on micro-granules. A new event of hypertensive crisis wasn`t happens, neither adverse effect didn`t see in the mother...

Legrado uterino o nifedipina durante el posparto en pacientes con preeclampsia severa / Curettage or nifedipine during the postpartum period in patients with severe preeclampsia

Comparar la eficacia del legrado uterino o la nifedipina durante el posparto en pacientes con preeclampsia severa. Maternidad “Dr. Nerio Belloso”, Hospital Central “Dr. Urquinaona”, Maracaibo. Estado Zulia. Se realizó una investigación en 60 pacientes con diagnóstico de preeclampsia severa que fueron divididas de la siguiente manera: grupo A (n = 30) que fueron sometidas a legrado uterino inmediatamente después del parto y grupo B (n = 30) que recibieron nifedipina (10 mg vía oral cada 8 horas x 24 horas). Se evaluaron los cambios en la presión arterial, contaje de plaquetas, parámetros de laboratorio y efectos adversos. La edad materna, edad de la gestación al momento del parto y tipo de parto fueron similar para las pacientes del grupo nifedipina y las pacientes del grupo de legrado uterino (p = ns). No se encontraron diferencias significativas en los valores promedio de presión arterial sistólica, presión arterial diastólica y contaje de plaquetas en ninguno de los períodos estudiados entre ambos grupos de estudio (p = ns). Tampoco encontraron diferencias estadísticamente significativas entre los grupos en los valores inicial y a las 24 horas de hemoglobina, hematocrito, bilirrubina y transaminasas (p =ns). El único efecto adverso que presentó una diferencia estadísticamente significativa y una alta incidencia fue la cefalea en el grupo de preeclámpticas severas tratadas con nifedipina (26 casos, P < 0,05). La nifedipina es tan eficaz como el legrado uterino durante el posparto en pacientes con preeclampsia severa

To compare the efficacy of uterine curettage or nifedipine during postpartum in patients with severe preeclampsia. Maternidad “Dr. Nerio Belloso”, Hospital Central “Dr. Urquinaona”, Maracaibo. Estado Zulia. A research was done in 60 patients with diagnosis of severe preeclampsia that were divided of following way: group A (n = 30) who were submitted to uterine curettage and group B (n = 30) who received nifedipine (10 mg orally every 8 hours x 24 hours). Blood pressure changes, platelet count, laboratory parameters and adverse effects were evaluated. Maternal age, gestational age at the moment of delivery and type of delivery were similar to patients of group nifedipine and patients of uterine curettage group (p = ns). There were not significant differences in mean values of systolic blood pressure, diastolic blood pressure and platelet count between groups (p = ns). There was also not significant differences between groups in initial and at 24-hours values of hemoglobin, hematocrit, bilirubin and transaminases (p = ns). The only adverse effect that presented a significant difference and a high incidence was headache in group of severe preeclamptic patients treated with nifedipine (26 cases; P < 0.05). Nifedipine is as effective as uterine curettage during postpartum in patients with severe preeclampsia

Disfunción del esfínter de Oddi y pancreatitis idiopática / Sphincter of Oddi dysfunction (SOD) and idiopatic pancreatitis

The sphincter of Oddi dysfunction is a little known entity that typically occurs in post-cholecystectomy patients with abdominal pain with biliary or pancreatic characteristics. It represents an important cause of idiopathic recurrent acute pancreatitis. Most of the patients referred for sphincter of Oddi dysfunction study have another disease which explain the symptoms, so a careful history and appropriate physical examination often can identify the true source of the pain. The most used grading score is the Milwaukee classification, based on clinical, laboratory, imaging and cholangiographic findings. In the last decade, new and more applicable criteria have been developed, such as Rome III criteria, which do not require functional tests considered complex and not available in non-specialized centers. The sphincter of Oddimanometry is considered the gold standard for the diagnosis of this entity, allowing for the determination of which patients will benefit from endoscopic therapy (sphincterotomy). There are some noninvasive diagnostic tests that have failed to show strong correlation to displace the sphincter of Oddi. The treatment of this condition is mainly based on endoscopic sphincterotomy, with variable success rates depending on the type of dysfunction. This article presents a review of the most important aspects related to the sphincter of Oddi and its relationship with idiopathic recurrent pancreatitis.

La disfunción del esfínter de Oddi es una entidad poco conocida, que típicamente se presenta en pacientes post-colecistectomía con dolor abdominal de tipo “biliar” o “pancreático”. Representa unaimportante causa de pancreatitis aguda recurrente idiopática. La mayoría de los pacientes derivados para estudio de disfunción del esfínter de Oddi corresponden a otra causa o enfermedad que explica los síntomas, por lo que una cuidadosa historia clínica y un adecuado examen físico, a menudo permiten identificar el verdadero origen del cuadro doloroso. La clasificación más utilizada es la de Milwaukee basada en parámetros clínicos, de laboratorio, imagenológicos y colangiográficos. En la última década, se han elaborado criterios de mayor aplicabilidad clínica como los criterios de Roma III, que no requieren de test funcionales considerados complejos y poco disponibles en centros no especializados. La manometría del esfínter de Oddi es considerado el gold standard en el diagnóstico de esta entidad, permitiendo además, establecer quiénes se beneficiarán con la terapia endoscópica (esfinterotomía). Se han desarrollado una serie de otros métodos diagnósticos no invasivos, que no han logrado demostrar una correlación suficientemente sólida para desplazar a la manometría. El tratamiento de esta condición se basa principalmente en la esfinterotomía endoscópica, con una tasa de éxito variable dependiendo del tipo de disfunción. En el presente artículo se revisarán los aspectos más importantes relacionados con la disfunción del esfínter de Oddi y su relación con pancreatitis recurrente idiopática.

Nifedipina comprimidos versus agonistas beta adrenergicos endovenosos para el tratamiento de la amenaza de parto prematura / Nifedipine tablets versus intravenous beta adrenergic agonists for the treatment of the threat of premature delivery

Manejo farmacológico seguro y eficaz de la amenaza del parto prematuro en la Provincia de Neuquén. \r\nSe realizó una evaluación de tecnología para responder a la siguiente pregunta de investigación: En mujeres embarazadas con amenaza de parto prematuro, la Nifedipina comprimidos de 10 mg es superior al Ritodrine ampollas, en términos de efectividad y seguridad para la madre y el niño? Distintos investigadores realizaron búsquedas bibliográficas independientes en diversas bases de datos. Se encontraron revisiones sistemáticas y meta-análisis de múltiples estudios randomizados y controlados comparando la Nifedipina con los agonistas beta adrenérgicos. También se hallaron guías de práctica clínica y recomendaciones de la OMS. \r\nSe interpreta que hay suficiente evidencia científica que sostiene que la Nifedipina comprimidos es superior al Ritodrine endovenoso en términos de efectividad y seguridad para la madre y el niño. Estas diferencias son estadísticamente significativas, clínicamente relevantes, y los resultados muestran coherencia entre las \r\nmúltiples investigaciones realizadas en distintas poblaciones, por lo que el Comité Provincial de Medicamentos de Neuquén realiza la recomendación fuerte de incorporar a la Nifedipina comprimidos de 10 mg como medicamento de elección en la amenaza de parto prematuro, reemplazando al Ritodrine.

Uso de nifedipina e incidência de lesão renal aguda em pós-operatório de cirurgia de revascularização do miocárdio com CEC / Use of nefidipine and acute kidney injury incidence in postoperative of myocardial revascularization surgery with cardiopulmonary bypass

OBJETIVO: Avaliar durante o período perioperatório o uso da nifedipina na incidência de lesão renal aguda dos pacientes submetidos à revascularização do miocárdio com circulação extracorpórea. MÉTODOS: Foram estudados, de modo prospectivo e sequencial, 94 pacientes submetidos à revascularização do miocárdio com circulação extracorpórea. As dosagens da creatinina sérica foram realizadas durante pré-operatório e pós-operatório de 24, 48 horas e no 7º dia. Estabeleceu-se como definição para presença de lesão renal a elevação da creatinina sérica 30 por cento em relação ao seu valor basal nas primeiras 24 ou 48 horas de pós-operatório. Os pacientes foram divididos em quatro grupos: G1, que recebeu nifedipina no pré-operatório; G2, que recebeu nifedipina no pós-operatório; G3, que recebeu nifedipina no pré e pós-operatórios e, G4, que não recebeu nifedipina. RESULTADOS: O grupo G4 mostrou maior elevação do percentual de creatinina sérica e maior percentual de pacientes que apresentaram insuficiência renal aguda em relação aos demais grupos no pós-operatório. CONCLUSÃO: Os valores da creatinina sérica e a incidência de lesão renal aguda no pós-operatório sugerem possível efeito nefroprotetor da nifedipina em pacientes submetidos à revascularização do miocárdio com circulação extracorpórea.

OBJECTIVE: The objective of this work was to evaluate the influence of the use of nifedipine on the outcome of renal function in patients undergoing myocardial revascularization with extracorporeal circulation. METHODS: The casuistics and variables related to extracorporeal circulation were studied. Serum creatinine levels were measured preoperatively, 24, 48 hours and on 7th day postoperatively. Renal failure was defined as an increase in 30 percent of serum creatinine levels at 24 or 48 hours postoperatively compared to those at baseline. Patients were assigned to four groups: G1 (patients who received nifedipine preoperatively); G2 (patients who received nifedipine postoperatively); G3 (patients who received nifedipine pre and postoperatively) and G4 (patients who did not receive nifedipine). RESULTS: The mean serum creatinine levels postoperatively presented greater rise in G4 (G4>G1=G2=G3), and G4 also presented a higher percentage of patients with acute renal failure (G4>G1 and G4>G3, P<0.05; G1=G3 and G2=G4, P>0.05). CONCLUSION: The evaluation of serum creatinine values and incidence of acute kidney injury postoperatively suggest a possible nefro-potective effect of nifedipine in patients undergoing myocardial revascularization with extracorporeal circulation.

Efeitos hemodinâmicos da nifedipina na inibição do trabalho de parto prematuro / Hemodynamics effects of nifedipine as a tocolytic agent in preterm labour

Realizou-se revisão da literatura a respeito do uso da nifedipina no trabalho de parto prematuro, descrevendo-se os principais aspectos farmacológicos, eficiência como agente de tocólise, bem como os potenciais efeitos adversos maternos e fetais, com ênfase na hemodinâmica útero-placentária. De acordo com as evidências atuais, a nifedipina é a medicação de escolha para tocólise, apresentando boa eficácia na inibição das contrações uterinas, custo mais baixo quando comparada aos demais fármacos e melhor tolerância materna por ter menos efeitos colaterais, sobretudo em relação aos betamiméticos. Os efeitos colaterais maternos mais freqüentes com o uso da medicação são a cefaléia, a fadiga e o rubor cutâneo. Os efeitos adversos fetais são pouco conhecidos. Pesquisas futuras são necessárias objetivando encontrar um regime posológico padrão que apresente boa eficácia tocolítica e nenhum ou mínimos efeitos adversos para o binômia materno-fetal.

A literature review on nifedipine in preterm labour was performed describing its pharmacological aspects, efficiency as tocolytic agent and its potential maternal-fetal side effects, emphasizing utero-placental hemodynamics. Recent evidence supports the use of nifedipine as medication of choice for tocolysis, presenting a satisfactory action to inhibit uterine contraction, lower proce when compared to other tocolytics agents and better maternal tolerance. The most frequent side effects with nifedipine for tocolysis are cutaneous flush, headache and fatigue. Fetal side effects are less known. Future research is necessary to find an ideal nifedipine posologic scheme which presents a satisfactory tocolysis performance and none or minimal maternal-fetal side effects.

Curso de Atualização em emergências médicas: aula 2: Urgências e emregências hipertensivas / Medical emergencies actualization course: class 2: hypertensive urgencies and emergencies

A hipertensão arterial é uma condição clínica com alta prevalência em todo o mundo, sendo fundamental estar atento às suas possíveis complicações. As emergências hipertensivas são condições associadas a risco iminente de vida, associadas à perda rápida da função de órgãos-alvo. Nesses casos a redução da pressão arterial deve ser imediata, em horas ou minutos. Nas urgências hipertensivas esse risco também existe, mas a redução da pressão arterial pode ser mais gradual, em cerca de 24 horas.

Eclampsia : before and after magnesium sulphate.

This study was done to see the incidence and impact of changes in the intervention strategy for the management of eclampsia in a maternity hospital on maternal and perinatal outcome. Analysis of case records of all eclampsia cases over two different study periods designated as study period A (April, 1994 to Oct, 1996) and study period B (April, 2000 to April, 2001) were done. Total number of eclampsia cases who received intervention over two different study period (46 in study period A and 47 in study period B) were comparable despite the difference in the duration of study period. During study period A, diazepam was used as anticonvulsant, whereas magnesium sulphate was used to control fits during study period B. Incidence of eclampsia has markedly increased in this hospital (0.12% vs 0.29%). Epidemiology and clinical profile of eclamptic patients do not show remarkable change. There was no maternal death in study period B (April, 2000 to April, 2001) whereas there was one maternal death in the study period A (April, 1994 to October, 1996). Marked improvement was noticed in terms of recurrence of fit (19.13% vs 73.91%) with change in the intervention strategy. Perinatal deaths were fewer in study period B (20% vs 33%). Overall, it seems that care of eclamptic patients and use of magnesium sulphate as anticonvulsant has resulted in positive impact on maternal outcome.