Caracterização do uso de hipodermóclise em pacientes internados em um Hospital Infantil de Belo Horizonte / Characterization of the use of hypodermoclysis in patients admitted to a Children's Hospital in Belo Horizonte

Introdução: A hipodermóclise consiste na inserção de um cateter via subcutânea para reposição de fluidos e administração de fármacos. Há poucos estudos clínicos que comprovem sua eficácia e segurança para administração de fármacos. Objetivos: Caracterizar o uso da hipodermóclise em pacientes internados em um hospital pediátrico em Belo Horizonte. Métodos: Estudo descritivo, observacional, de coorte transversal e com abordagem quantitativa, utilizando dados de prontuário eletrônico e realizado em uma instituição hospitalar da rede pública de saúde no estado de Minas Gerais no período de 2017 a 2018. Resultados: 27 pacientes fizeram uso da hipodermóclise n=17 (56%) tinham idade inferior a cinco anos, a indicação do cateter foi mais usual na unidade de cuidados paliativos n=12(43%). A região subclavicular foi o sítio mais puncionado n=31 (51,7%), tempo de permanência do cateter entre 1 e 5 dias n=31 (51,7%) e os principais motivos para a retirada foram: sinais flogísticos n=12 (20%) e exteriorização acidental do dispositivo n=10 (16,7%). Foram prescritos 12 fármacos diferentes por esta via sendo a morfina a mais utilizada n=15 (28,9%) e as principal indicação foi para o conforto e controle da dor n=22 (42%). Conclusão: A hipodermóclise é um método seguro e de baixo custo. Novas pesquisas na população geral e pediátrica são fundamentais para produzir evidências da segurança e efetividade desta via.

Introduction: Hypodermoclysis consists of inserting a subcutaneous catheter to replace fluids and administer drugs. There are few clinical studies that prove its efficacy and safety for drug administration. Purpose: To characterize the use of hypodermoclysis in patients admitted to a pediatric hospital in Belo Horizonte. Methods: Descriptive, observational, cross-sectional cohort study with a quantitative approach, using data from electronic medical records and carried out in a public health hospital in the state of Minas Gerais in the period from 2017 to 2018. Results: 27 patients who used hypodermoclysis n=17 (56%) were under the age of five years, the indication of the catheter was more usual in the palliative care unit n=12 (43%). The subclavicular region was the most punctured site n=31 (51,7%), catheter dwell time between 1 and 5 days n=31 (51,7%) and the main reasons for the withdrawal were: inflammatory signs n=12 (20%) and accidental externalization of the device n=10 (16,7%) 12 different drugs were prescribed by this route, with morphine being the most used n=15 (28,9%) and the main indication was for comfort and pain control n=22 (42%). Conclusion: Hypodermoclysis is a safe and low-cost method. New research in the general and pediatric population is essential to produce evidence of the safety and effectiveness of this route.

Development and validation of an instrument (CSII - Brazil) to assess users' conceptual and procedural knowledge of continuous subcutaneous infusion systems

ABSTRACT Objective: To develop, adapt and validate an instrument named "CSII - Brazil" to assess users' conceptual and procedural knowledge of continuous subcutaneous insulin infusion systems. Materials and methods: Methodological and exploratory study developed in three stages: a) instrument development; b) content validation and cultural adaptation (evaluation by a committee of experts and pre-test with CSII users); c) psychometric validation through instrument application in a sample of 60 patients by means of the web tool e-Surv. Internal consistency and reproducibility analyses were performed within IBM SPSS Statistics 20 programming environment. Results: The 16 multiple-choice question instrument successfully attained a content validity index of 0.97, showing satisfactory internal consistency, with 0.61 Cronbach's alpha [95% CI 0.462-0.746] and an intraclass correlation coefficient of 0.869 [95% CI: 0.789-0.919] between the test and retest scores. Conclusion: The CSII - Brazil instrument is considered adequate and validated to assess continuous subcutaneous infusion system users' conceptual and procedural knowledge.

Complicações relacionadas à punção venosa periférica e à hipodermóclise em pacientes oncológicos sob cuidados paliativos / Complications related to peripheral venipuncture and hypodermoclysis in cancer patients under palliative care / Complicaciones relacionadas con la venopunción periférica y la hipodermoclisis en pacientes oncológicos en cuidados paliativos

Objetivo: identificar complicações relacionadas à punção venosa periférica e à hipodermóclise em pacientes oncológicos hospitalizados sob cuidados paliativos. Método: estudo descritivo e longitudinal. Foi utilizado questionário para caracterização sociodemográfica e clínica dos participantes, roteiro para a avaliação e acompanhamento da punção. Os dados foram analisados por meio da estatística descritiva. Resultados: participaram do estudo 70 pacientes, sendo 54,3% (n=38) do sexo feminino e com idade média de 68,8 anos (DP = 15,0), cujas principais doenças oncológicas de base foram câncer de cabeça e pescoço e de pulmão. Ademais, 90% das punções avaliadas foram endovenosas e as complicações mais frequentes foram dor local, extravasamento e cateter dobrado ou tracionado. Conclusão: as complicações observadas no período do estudo foram relacionadas apenas às punções venosas. Houve predominância da punção venosa periférica em detrimento da via subcutânea, uma alternativa viável e recomendada para os pacientes oncológicos sob cuidados paliativos.

Objective: to identify complications related to peripheral venipuncture and hypodermoclysis in cancer patients hospitalized under palliative care. Method: this is a descriptive and longitudinal study. A questionnaire was used for the sociodemographic and clinical characterization of participants, a script for puncture assessment and monitoring. The data were ran through descriptive statistics. Results: seventy patients participated in the study, 54.3% (n=38) of whom were female and with a mean age of 68.8 years (SD = 15.0), whose main underlying oncological diseases were head cancer and neck and lung. Furthermore, 90% of assessed punctures were intravenous and the most frequent complications were localized pain, extravasation and a bent or pulled catheter. Conclusion: the complications observed during the study period were related only to venipunctures. There was a predominance of peripheral venipuncture due to the subcutaneous route, a viable and recommended alternative for cancer patients under palliative care.

Objetivo: identificar las complicaciones relacionadas con la venopunción periférica y la hipodermoclisis en pacientes con cáncer hospitalizados bajo cuidados paliativos. Método: estudio descriptivo y longitudinal. Se utilizó un cuestionario para la caracterización sociodemográfica y clínica de los participantes, un guión para la valoración y seguimiento de la punción. Los datos fueron analizados utilizando estadística descriptiva. Resultados: en el estudio participaron 70 pacientes, de los cuales el 54,3% (n=38) eran mujeres y con una edad media de 68,8 años (DE=15,0), cuyas principales patologías oncológicas de base fueron cabeza y cuello y pulmón. Además, el 90% de las punciones evaluadas fueron intravenosas y las complicaciones más frecuentes fueron dolor local, extravasación y catéter doblado o tirado. Conclusión: las complicaciones observadas durante el período de estudio se relacionaron únicamente con las punciones venosas. Predominó la punción venosa periférica en detrimento de la vía subcutánea, alternativa viable y recomendada para pacientes oncológicos en cuidados paliativos.

Caracterização de pacientes sob cuidados paliativos submetidos à punção venosa periférica e à hipodermóclise / Caracterización de pacientes en atención paliativa sometidos a una punción venosa periférica e hipodermoclisis / Characterization of patients under palliative care submitted to peripheral venipuncture and hypodermoclysis

Objetivo: caracterizar os pacientes oncológicos internados sob cuidados paliativos submetidos à punção venosa periférica e a hipodermóclise, segundo as variáveis sociodemográficas e clínicas. Método: estudo observacional, descritivo e prospectivo. Foram realizadas entrevistas com o paciente e/ou seu cuidador, consulta ao prontuário, avaliação e acompanhamento diário da punção. Resultados: participaram do estudo 45 pacientes de ambos os sexos e com idade superior a 18 anos. A avaliação funcional dos pacientes, no momento da internação, foi de 30%, indicando pacientes extremamente incapacitados e com necessidade de hospitalização. Os sintomas mais frequentes apresentados pelos pacientes no dia da internação foram inapetência, sonolência, fadiga, dispneia e dor. O número de punções venosas periféricas foi superior ao número de hipodermóclises realizadas. Conclusão: os dados analisados permitiram caracterizar o perfil de pacientes oncológicos internados sob cuidados paliativos e a terapêutica adotada para a terapia medicamentosa. Pôde-se, ainda, identificar a baixa adesão da equipe à realização da hipodermóclise, o que remete à necessidade da realização de mais estudos com altos níveis de evidência para embasar a prática assistencial da equipe de enfermagem e contribuir para a qualidade de vida do paciente.(AU)

Objective: To characterize cancer patients hospitalized under palliative care who underwent peripheral venipuncture and hypodermoclysis according to sociodemographic and clinical variables. Method: This is an observational, descriptive, and prospective study. Interviews were carried out with the patients and/or their caregiver, as well as consultation of medical records, evaluation, and daily monitoring of the puncture. Results: 45 patients of both genders and of 18+ years of age participated in the study. The functional assessment of patients at admission was 30%, indicating extremely disabled patients and in need of hospitalization. The most frequent symptoms presented by patients on the day of hospitalization were lack of appetite, drowsiness, fatigue, dyspnea, and pain. The number of peripheral venipunctures was higher than the number of hypodermoclyses performed. Conclusion: The analyzed data allowed to characterize the profile of cancer patients hospitalized under palliative care and the therapy adopted for drug therapy. It was also possible to identify the low adherence of the team to the performance of hypodermoclysis, which refers to the need for further studies with high levels of evidence to support the care practice of the nursing team and contribute to the patient's quality of life(AU)

Objetivo: caracterizar los pacientes con cáncer hospitalizados bajo cuidados paliativos, que se sometieron a venopunción periférica e hipodermoclisis de acuerdo con variables sociodemográficas y clínicas. Método: estudio observacional, descriptivo y prospectivo. Se realizaron entrevistas con el paciente y / o su cuidador, consulta de historias clínicas, evaluación y seguimiento diario de la punción. Resultados: 45 pacientes de ambos sexos y mayores de 18 años participaron en el estudio. La evaluación funcional de los pacientes al ingreso fue del 30%, lo que indica pacientes extremadamente discapacitados y que necesitan hospitalización. Los síntomas más frecuentes que presentaron el día de la hospitalización fueron: falta de apetito, somnolencia, fatiga, disnea y dolor. El número de punciones venosas periféricas fue mayor que el número de hipodermoclisis realizado. Conclusión: los datos analizados permitieron caracterizar el perfil de pacientes con cáncer hospitalizados bajo cuidados paliativos y el tratamiento adoptado para la terapia farmacológica. También fue posible identificar la baja adhesión del equipo a la realización de la hipodermoclisis, lo que remite a la necesidad de realizar más estudios con altos niveles de evidencia para apoyar la práctica de atención del equipo de enfermería y contribuir a la calidad de vida del paciente(AU)

Perfusión de furosemida subcutánea como tratamiento paliativo en insuficiencia cardiaca refractaria / Subcutaneous furosemide infusion as palliative treatment in refractory end-stage heart failure

Resumen En la insuficiencia cardiaca terminal los síntomas predominantes habitualmente están relacionados con la congestión; sin embargo, la resistencia a diuréticos vía oral es frecuente y necesita tratamiento parenteral para paliar los síntomas. La administración intravenosa de furosemida requiere hospitalización o asistencia hospitalaria, lo que supone un deterioro significativo de la calidad de vida de pacientes en fases avanzadas de la enfermedad. La administración subcutánea continua de furosemida mediante infusor elastomérico es una técnica eficaz con baja tasa de complicaciones graves que permite la administración de diurético parenteral en el ámbito domiciliario, y evita la necesidad de hospitalizar. A pesar de que esta modalidad de tratamiento no está aceptada en ficha técnica y requiere más estudios que precisen su indicación, puede suponer un recurso adecuado para pacientes seleccionados. Se presenta el caso de una paciente con insuficiencia cardiaca avanzada, síntomas congestivos y ausencia de respuesta a tratamiento deplectivo vía oral, tratada con perfusión continua subcutánea domiciliaria de furosemida mediante infusor elastomérico de forma prolongada.

Abstract In end-stage heart failure the predominant symptoms are usually associated with congestion. However, the resistance to oral diuretics is common and requires parenteral treatment to alleviate the symptoms. The intravenous administration of furosemide requires hospital admission or hospital care. This leads to a significant decrease in the quality of life of patients in advance stages of the disease. The continuous subcutaneous infusion of furosemide using an elastomeric pump is an effective technique, with a low rate of serious complications that allows a parenteral diuretic to be administered in the home environment and thus avoiding the need for hospital admission. Despite this mode of treatment not being indicated in the drug data sheet, and requires more studies that specify its indication, it may be a suitable recourse for selected patients. It is presented a case of a patient with advanced heart failure, congestive symptoms, and a lack of response to oral diuretics treatment, and then treated with a continuous and prolonged subcutaneous infusion of furosemide at home using an elastomeric infusion pump.

Histone deacetylase inhibition attenuates hepatic steatosis in rats with experimental Cushing's syndrome

Cushing's syndrome (CS) is a collection of symptoms caused by prolonged exposure to excess cortisol. Chronically elevated glucocorticoid (GC) levels contribute to hepatic steatosis. We hypothesized that histone deacetylase inhibitors (HDACi) could attenuate hepatic steatosis through glucocorticoid receptor (GR) acetylation in experimental CS. To induce CS, we administered adrenocorticotropic hormone (ACTH; 40 ng/kg/day) to Sprague-Dawley rats by subcutaneous infusion with osmotic mini-pumps. We administered the HDACi, sodium valproate (VPA; 0.71% w/v), in the drinking water. Treatment with the HDACi decreased steatosis and the expression of lipogenic genes in the livers of CS rats. The enrichment of GR at the promoters of the lipogenic genes, such as acetyl-CoA carboxylase (Acc), fatty acid synthase (Fasn), and sterol regulatory element binding protein 1c (Srebp1c), was markedly decreased by VPA. Pan-HDACi and an HDAC class I-specific inhibitor, but not an HDAC class II a-specific inhibitor, attenuated dexamethasone (DEX)-induced lipogenesis in HepG2 cells. The transcriptional activity of Fasn was decreased by pretreatment with VPA. In addition, pretreatment with VPA decreased DEX-induced binding of GR to the glucocorticoid response element (GRE). Treatment with VPA increased the acetylation of GR in ACTH-infused rats and DEX-induced HepG2 cells. Taken together, these results indicate that HDAC inhibition attenuates hepatic steatosis hrough GR acetylation in experimental CS.

Dental caries and bacterial load in saliva and dental biofilm of type 1 diabetics on continuous subcutaneous insulin infusion

Abstract Objectives Since most of the studies evaluates diabetics on multiple daily injections therapy and continuous subcutaneous insulin infusion may help gain better metabolic control and prevent complications, the objective of this study was to evaluate the prevalence of dental caries, the unstimulated salivary flow rate and the total bacteria load, Streptococcus spp. levels and Lactobacillus spp. levels in saliva and supragingival dental biofilm of type 1 diabetics on insulin pump. Material and Methods Sixty patients with type 1 diabetes on insulin pump and 60 nondiabetic individuals were included. The dental caries evaluation was performed using ICDAS and the oral hygiene was assessed according to Greene and Vermillion Simplified Oral Hygiene Index. Unstimulated saliva and supragingival dental biofilm were collected. Total bacteria, Streptococcus spp. and Lactobacillus spp. was quantified by qPCR. Results Patients with type 1 diabetes had a higher prevalence of dental caries and filled and missing teeth when compared with the control group. These patients were associated with more risk factors for the development of dental caries, namely a lower unstimulated salivary flow rate and a higher bacterial load in saliva and dental biofilm. Conclusion Some risk factors related to dental caries were associated with type 1 diabetics. An early diagnosis combined with the evaluation of the risk profile of the diabetic patient is imperative, allowing the dental caries to be analyzed through a perspective of prevention and the patient to be integrated into an individualized oral health program.

Nursing knowledge and practices regarding subcutaneous fluid administration / Conocimientos y prácticas de enfermería en la administración de fluidos por vía subcutánea / Conhecimentos e práticas da enfermagem na administração de fluidos por via subcutânea

ABSTRACT Objective: To describe the evidence in the literature regarding the knowledge and practices of the nursing team about subcutaneous administration of drugs and fluids in adults. Method: Integrative review of the literature using the descriptors "nursing", "hypodermoclysis", "drug administration routes", "adult health," and "knowledge," in English, Spanish, and Portuguese, with no publication deadline. Of the 569 articles found, eight made up the sample. Results: A predominance of international journals (75%) with more than five years of publication (62.5%). The analysis of the methodological characteristics showed a predominance of literature reviews (25%), quantitative studies (62.5%), cross-sectional studies (50%), and non-experimental studies (50%). Conclusion: Although it is an old technique with proven efficacy, hypodermoclysis is still little used, a puzzling fact due to its advantages and indications for any age.

RESUMEN Objetivo: Describir las evidencias, en la literatura, acerca de los conocimientos y prácticas del equipo de enfermería sobre administración de medicamentos y fluidos por vía subcutánea en adultos. Método: Revisión integrativa de la literatura, utilizando los descriptores: enfermería, hipodermoclisis, vías de administración de medicamentos, salud del adulto y conocimiento; en idiomas inglés, español y portugués, sin fecha límite de publicación. Fueron encontrados 569 artículos, de los cuales 8 integraron la muestra. Resultados: Predominio de revistas internacionales (75%), y con más de cinco años de publicación (62,5%). Al analizarse las características metodológicas, predominaron: revisiones de literatura (25%), estudios cuantitativos (62,5%), estudios transversales (50%) y no experimentales (50%). Conclusión: A pesar de tratarse de una técnica antigua de comprobada eficacia, la hipodermoclisis es aún poco utilizada, hecho inexplicable, dadas sus ventajas e indicaciones para cualquier edad.

RESUMO Objetivo: descrever as evidências, na literatura, sobre os conhecimentos e as práticas da equipe de enfermagem na administração de medicamentos e de fluidos por via subcutânea no adulto. Método: revisão integrativa da literatura utilizando os descritores enfermagem, hipodermóclise, vias de administração de medicamentos, saúde do adulto e conhecimento; nos idiomas inglês, espanhol e português, sem data limite de publicação. Dos 569 artigos encontrados, oito compuseram a amostra. Resultados: predomínio de revistas internacionais (75%) e com mais de cinco anos de publicação (62,5%). Ao analisarem-se as características metodológicas, predominaram: revisões de literatura (25%), estudos quantitativos (62,5%), estudos transversais (50%) e não-experimentais (50%). Conclusão: apesar de se tratar de uma técnica antiga com eficácia comprovada, a hipodermóclise ainda é pouco utilizada, fato incoerente pelas suas vantagens e suas indicações para qualquer idade.

Flecainide Improve Sepsis Induced Acute Lung Injury by Controlling Inflammatory Response / 대한구급학회지

BACKGROUND: Flecainide is an antiarrhythmic agent that is used primarily in the treatment of cardiac arrhythmias. Some evidences also suggest that flecainide can participate in alveolar fluid clearance and inflammatory responses. This experiment was aimed to evaluate the effects of flecainide on sepsis induced acute lung injury in a rat model. METHODS: Rats were treated with subcutaneous infusion of saline or flecainide (0.1 or 0.2 mg/kg/hr) by a mini-osmotic pump. Subcutaneous infusion was started 3 hours before and continued until 8 hours after intraperitoneal injection of saline or endotoxin. Animals were sacrificed for analyses of severity of acute lung injury with wet to dry (W/D) ratio and lung injury score (LIS) in lung and inflammatory responses with level of leukocyte, polymorphonuclear neutrophils (PMNs) and inteleukin-8 (IL-8) in bronchoalveolar lavages fluid (BALF). RESULTS: Flecainide markedly improved dose dependently sepsis induced acute lung injury as analysed by W/D ratio (from 2.24 ± 0.11 to 1.76 ± 0.09, p < 0.05) and LIS (from 3 to 1, p < 0.05), and inflammatory response as determined by leukocyte (from 443 ± 127 to 229 ± 95, p < 0.05), PMNs (from 41.43 ± 17.63 to 2.43 ± 2.61, p < 0.05) and IL-8 (from 95.00 ± 15.28 to 40.00 ± 10.21, p < 0.05) in BALF. CONCLUSIONS: Flecanide improve sepsis induced acute lung injury in rats by controlling inflammatory responses.

Flecainide Improve Sepsis Induced Acute Lung Injury by Controlling Inflammatory Response / 대한중환자의학회지

BACKGROUND: Flecainide is an antiarrhythmic agent that is used primarily in the treatment of cardiac arrhythmias. Some evidences also suggest that flecainide can participate in alveolar fluid clearance and inflammatory responses. This experiment was aimed to evaluate the effects of flecainide on sepsis induced acute lung injury in a rat model. METHODS: Rats were treated with subcutaneous infusion of saline or flecainide (0.1 or 0.2 mg/kg/hr) by a mini-osmotic pump. Subcutaneous infusion was started 3 hours before and continued until 8 hours after intraperitoneal injection of saline or endotoxin. Animals were sacrificed for analyses of severity of acute lung injury with wet to dry (W/D) ratio and lung injury score (LIS) in lung and inflammatory responses with level of leukocyte, polymorphonuclear neutrophils (PMNs) and inteleukin-8 (IL-8) in bronchoalveolar lavages fluid (BALF). RESULTS: Flecainide markedly improved dose dependently sepsis induced acute lung injury as analysed by W/D ratio (from 2.24 ± 0.11 to 1.76 ± 0.09, p < 0.05) and LIS (from 3 to 1, p < 0.05), and inflammatory response as determined by leukocyte (from 443 ± 127 to 229 ± 95, p < 0.05), PMNs (from 41.43 ± 17.63 to 2.43 ± 2.61, p < 0.05) and IL-8 (from 95.00 ± 15.28 to 40.00 ± 10.21, p < 0.05) in BALF. CONCLUSIONS: Flecanide improve sepsis induced acute lung injury in rats by controlling inflammatory responses.

Efeitos adversos da hipodermóclise em pacientes adultos: revisão integrativa / Adverse effects of hypodermoclysis in adult patients: an integrative review / Efectos adversos de hipodermoclisis en pacientes adultos: una revisión integradora

A hipodermóclise é uma técnica indicada para a desidratação leve a moderada, principalmente em pacientes idosos ou que estão sob cuidados paliativos. É subutilizada na prática clínica, pelo desconhecimento dos profissionais e pelo relato de efeitos adversos. Este artigo é uma revisão integrativa que identificou na literatura artigos relacionados aos efeitos adversos da hipodermóclise em pacientes adultos. Foi realizada busca no portal Pubmed e nas bases de dados Embase, Lilacs, Scopus, Cinahl e Scielo. Identificaram-se 13 artigos, dos quais cinco foram revisões de literatura, três eram coortes, dois ensaios clínicos randomizados, um relato de caso, uma revisão sistemática e um relato de experiência. Os efeitos adversos mais relatados foram dor local e sobrecarga de líquidos em 61% dos estudos, edema local em 53% e celulite em 38%. Concluiu-se que os efeitos adversos foram mínimos e similares à via endovenosa e a técnica se mostrou segura e eficaz.

The Hypodermoclisis is an indicated technique for mild to moderate dehydration, especially in elderly patients or those under palliative care. It is underutilized in clinical practice, due to the lack of knowledge of the professionals and the report of adverse effects. This article is an integrative review that has identified in the literature articles related to the adverse effects of hypodermoclisis in adult patients. We searched the Pubmed portal and the Embase, Lilacs, Scopus, Cinahl and Scielo databases. We identified 13 articles, of which five were literature reviews, three were cohorts, two randomized clinical trials, one case report, one systematic review and one experience report. The most commonly reported adverse events were local pain and fluid overload in 61% of the studies, local edema in 53% and cellulitis in 38%. It was concluded that the adverse effects were minimal and similar to the intravenous route and the technique proved to be safe and effective.

La hipodermoclisis es una técnica indicada para los casos leves de deshidratación moderada, especialmente en pacientes de edad avanzada o aquellos que están bajo los cuidados paliativos. Se infrautilizado en la práctica clínica, la falta de profesionales y la notificación de los efectos adversos. Este artículo es una revisión integradora que identificó en los artículos de la literatura relacionada con los efectos adversos de hipodermoclisis en pacientes adultos. Se realizó una búsqueda en el portal de PubMed y Embase en las bases de datos LILACS, Scopus, CINAHL y Scielo. 13 artículos han sido identificados, de los cuales cinco son revisión de la literatura, había tres cohortes, dos ensayos clínicos aleatorios, uno de reporte de casos, una revisión sistemática y experiencia de informes. Los eventos adversos más frecuentes fueron dolor local y la sobrecarga de líquidos en el 61% de los estudios, edema local en el 53% y la celulitis en un 38%. Se concluyó que los efectos adversos fueron mínimos y similares para vía intravenosa y la técnica han demostrado ser seguro y eficaz.

Evaluation of the anti-inflammatory and analgesic effects of green tea (Camellia sinensis) in mice

PURPOSE: To evaluate the anti-inflammatory and analgesic effects of green tea (Camellia sinensis) in mice. METHODS: The anti-inflammatory effect of alcoholic extracts of green tea (AE) was evaluated in a cell migration assay with four groups of six Swiss mice receiving 0.07g/Kg or 0.14g/Kg EA (treatment groups), saline (negative control) or 10mg/Kg indomethacin (positive control) by gavage. One hour later 300 µg carrageen an was administered intraperitoneally or subcutaneously. The analgesic effect was evaluated using four groups of six animals receiving 0.07g/Kg or 0.14g/Kg EA, saline or 10mg/Kg indomethacin subcutaneously, followed 30 minutes later by 1% acetic acid. RESULTS: When administered subcutaneously at either dose (0.07g/Kg and 0.14g/Kg), AE inhibited carrageenan-induced cell migration (p<0.05). However, when administered by gavage, only the latter (0.14 g/Kg) was efficient (p<0.05). AE at both doses (0.07g/Kg and 0.14g/Kg) inhibited abdominal contortions (p<0.05), but the effect was not dose-dependent. CONCLUSION: Green tea was shown to have analgesic and anti-inflammatory properties and may constitute a natural treatment option in chronic inflammatory disorders. .

Evaluation of diabetic patients after three month use of continuous subcutaneous insulin infusion, dispensed by a protocolled form at outpatient reference clinic of Taguatinga Regional Hospital

Objective To evaluate the data of continuous subcutaneous insulin infusion protocol (CSII) for diabetics waived by the Health State Secretariat of Distrito Federal (HSSDF) and therapeutic responses three months after the transfer of multiple daily injections regimen for CSII. Subjects and methods Eighty patients (49 female) took part in this experimental study, mean age and disease duration were 27.9 years and 13 years, respectively; 96% patients had type 1 diabetes mellitus. Results The entire sample (ECO) and 3 subgroups (group 1 – A1c decrease, group 2 – A1c stable, and group 3 – A1c increase), stratified according to a ≥ 0.5% change in A1c, were analyzed. Group 1 involved 64% of the patients. The ECO showed a significant A1c decrease: MDI 8.1 ± 1.4% vs. CSII 7.3 ± 0.9%, p < 0.0001 (0.8% difference pro CSII therapy). Group 1 demonstrated an A1c decrease from 8.7% to 7.3% (1.4% difference). Group 2 mean A1c was 7.1%. Rate of hypoglycemia (< 50 mg/dL) decreased 61% in the ECO and 79% in Group 2. Conclusion This study reinforces the safety and efficacy of CSII with a robust A1c reduction and hypoglycemia. The pioneer care HSSDF ambulatory attests to be achievable the free dispensing by Unified Health System (UHS) following a protocol, and this approach results in less wastage to the patient and represents a rational policy of therapy with CSII for UHS. Arch Endocrinol Metab. 2015;59(1):23-8 .

Congenital hyperinsulinism: current status and future perspectives

The diagnosis and treatment of congenital hyperinsulinism (CHI) have made a remarkable progress over the past 20 years and, currently, it is relatively rare to see patients who are left with severe psychomotor delay. The improvement was made possible by the recent developments in the understanding of the molecular and pathological basis of CHI. Known etiologies include inactivating mutations of the K(ATP) channel genes (ABCC8 and KCNJ11) and HNF4A, HNF1A, HADH, and UCP2 or activating mutations of GLUD1, GCK, and SLC16A1. The understanding of the focal form of K(ATP) channel CHI and its detection by 18F-fluoro-L-DOPA positron emission tomography have revolutionized the management of CHI, and many patients can be cured without postoperative diabetes mellitus. The incidence of the focal form appears to be higher in Asian countries; therefore, the establishment of treatment systems is even more important in this population. In addition to diazoxide or long-term subcutaneous infusion of octreotide or glucagon, long-acting octreotide or lanreotide have also been used successfully until spontaneous remission. Because of these medications, near-total pancreatectomy is less often performed even for the diazoxide-unresponsive diffuse form of CHI. Other promising medications include pasireotide, small-molecule correctors such as sulfonylurea or carbamazepine, GLP1 receptor antagonists, or mammalian target of rapamycin inhibitors. Unsolved questions in this field include the identification of the remaining genes responsible for CHI, the mechanisms leading to transient CHI, and the mechanisms responsible for the spontaneous remission of CHI. This article reviews recent developments and hypothesis regarding these questions.

Use of the On-Q system for pain management after robot - assisted endoscopic transaxillary thyroidectomy

BACKGROUND: The robot-assisted transaxillary approach to thyroid surgery is a novel method that has recently been used to improve patient safety and cosmetic outcomes. We evaluated post-operative pain, following robot-assisted endoscopic transaxillary thyroid surgery, and pain relief using a continuous wound perfusion system with local anesthetics. METHODS: In a control group of 25 female patients who underwent robot-assisted endoscopic transaxillary thyroidectomy, the post-operative pain scores and characteristics as well as analgesic use were monitored. Fifty female patients undergoing robot-assisted endoscopic transaxillary thyroidectomy were given the On-Q system. They were then randomly assigned to receive one of two different local anesthetic doses: Group I (0.25% Ropivacaine, n = 25); and Group II (0.375% Ropivacaine, n = 25). The pain score, pain site, analgesic requirements and side effects of each group were recorded during the 48 hour period post-surgery. RESULTS: Post-operative pain scores and analgesic demand were lower in the On-Q groups than in the control group. No difference was found between Group I and Group II. Until 6-12 hours after surgery, pain was mainly located in the axilla, while after 6-12 hours, the primary location of pain had a tendency to move to the neck. Pain scores gradually decreased in time for all patients. CONCLUSIONS: Patients who underwent robot-assisted endoscopic transaxillary thyroidectomy with an On-Q system injecting 0.25% ropivacaine had lower pain scores, showing the effectiveness of the system. As a potential pain blocker, continuous wound perfusion with the On-Q system attenuates side effects. This could lead to shortened hospital stays after robot-assisted endoscopic transaxillary thyroidectomy.

Use of the On-Q system for pain management after robot - assisted endoscopic transaxillary thyroidectomy

BACKGROUND: The robot-assisted transaxillary approach to thyroid surgery is a novel method that has recently been used to improve patient safety and cosmetic outcomes. We evaluated post-operative pain, following robot-assisted endoscopic transaxillary thyroid surgery, and pain relief using a continuous wound perfusion system with local anesthetics. METHODS: In a control group of 25 female patients who underwent robot-assisted endoscopic transaxillary thyroidectomy, the post-operative pain scores and characteristics as well as analgesic use were monitored. Fifty female patients undergoing robot-assisted endoscopic transaxillary thyroidectomy were given the On-Q system. They were then randomly assigned to receive one of two different local anesthetic doses: Group I (0.25% Ropivacaine, n = 25); and Group II (0.375% Ropivacaine, n = 25). The pain score, pain site, analgesic requirements and side effects of each group were recorded during the 48 hour period post-surgery. RESULTS: Post-operative pain scores and analgesic demand were lower in the On-Q groups than in the control group. No difference was found between Group I and Group II. Until 6-12 hours after surgery, pain was mainly located in the axilla, while after 6-12 hours, the primary location of pain had a tendency to move to the neck. Pain scores gradually decreased in time for all patients. CONCLUSIONS: Patients who underwent robot-assisted endoscopic transaxillary thyroidectomy with an On-Q system injecting 0.25% ropivacaine had lower pain scores, showing the effectiveness of the system. As a potential pain blocker, continuous wound perfusion with the On-Q system attenuates side effects. This could lead to shortened hospital stays after robot-assisted endoscopic transaxillary thyroidectomy.

Clinical Application of Glucagon-Like Peptide 1 Receptor Agonists for the Treatment of Type 2 Diabetes Mellitus

Glucagon-like peptide 1 (GLP-1) is secreted from enteroendocrine L-cells in response to oral nutrient intake and elicits glucose-stimulated insulin secretion while suppressing glucagon secretion. It also slows gastric emptying, which contributes to decreased postprandial glycemic excursions. In the 1990s, chronic subcutaneous infusion of GLP-1 was found to lower blood glucose levels in patients with type 2 diabetes. However, GLP-1's very short half-life, arising from cleavage by the enzyme dipeptidyl peptidase 4 (DPP-4) and glomerular filtration by the kidneys, presented challenges for clinical use. Hence, DPP-4 inhibitors were developed, as well as several GLP-1 analogs engineered to circumvent DPP-4-mediated breakdown and/or rapid renal elimination. Three categories of GLP-1 analogs, are being developed and/or are in clinical use: short-acting, long-acting, and prolonged-acting GLP-1 analogs. Each class has different plasma half-lives, molecular size, and homology to native GLP-1, and consequently different characteristic effects on glucose metabolism. In this article, we review current clinical data derived from each class of GLP-1 analogs, and consider the clinical effects reported for each category in recent head to head comparison studies. Given the relatively brief clinical history of these compounds, we also highlight several important efficacy and safety issues which will require further investigation.

Clinical Application of Glucagon-Like Peptide 1 Receptor Agonists for the Treatment of Type 2 Diabetes Mellitus

Glucagon-like peptide 1 (GLP-1) is secreted from enteroendocrine L-cells in response to oral nutrient intake and elicits glucose-stimulated insulin secretion while suppressing glucagon secretion. It also slows gastric emptying, which contributes to decreased postprandial glycemic excursions. In the 1990s, chronic subcutaneous infusion of GLP-1 was found to lower blood glucose levels in patients with type 2 diabetes. However, GLP-1's very short half-life, arising from cleavage by the enzyme dipeptidyl peptidase 4 (DPP-4) and glomerular filtration by the kidneys, presented challenges for clinical use. Hence, DPP-4 inhibitors were developed, as well as several GLP-1 analogs engineered to circumvent DPP-4-mediated breakdown and/or rapid renal elimination. Three categories of GLP-1 analogs, are being developed and/or are in clinical use: short-acting, long-acting, and prolonged-acting GLP-1 analogs. Each class has different plasma half-lives, molecular size, and homology to native GLP-1, and consequently different characteristic effects on glucose metabolism. In this article, we review current clinical data derived from each class of GLP-1 analogs, and consider the clinical effects reported for each category in recent head to head comparison studies. Given the relatively brief clinical history of these compounds, we also highlight several important efficacy and safety issues which will require further investigation.

Ampliação da indicação do metotrexato injetável para o tratamento da psoríase / Extending indication of methotrexate for the treatment of psoriasis

A psoríase é uma doença sistêmica inflamatória crônica, não contagiosa, que afeta a pele, as unhas e ocasionalmente as articulações. Costuma ter um curso recidivante e apresentação clínica variável. Afeta cerca de 2% da população mundial. No Brasil os dados disponíveis são do censo Dermatológico da Sociedade Brasileira de Dermatologia em que o diagnóstico de psoríase foi verificado em 1.349 pacientes de um total de 54.519 pessoas que consultaram dermatologistas em centros público e privados totalizando 2,5% dessa amostra. Pode ser incapacitante tanto pelas lesões cutâneas - fator importante de dificuldade de inserção social - quanto pela presença da forma articular que configura a artrite psoriásica. A psoríase tem sido classificada como doença autoimune, embora sua fisiopatologia não esteja completamente esclarecida. O papel de mecanismos imunes é documentado pela presença de linfócitos T ativados e macrófagos e pela boa resposta a terapias imunossupressoras. O metotrexato (MTX) é estruturalmente um análogo do ácido fólico e, dessa forma, inibe competitivamente a enzima dihidrofolato redutase (DHFR), interferindo na síntese do DNA e conseqüentemente na divisão celular. A sua ação na psoríase parece estar baseada mais na atuação como fármaco imunossupressor do que como agente anti-proliferativo, como se acreditava anteriormente. O MTX é administrado por via oral, subcutânea ou intramuscular em dose única semanal ou dividido em até 3 doses semanais com intervalo de 12h. A dose inicial é de 7,5 mg e pode ser aumentada gradualmente até obtenção de resposta clínica ou dose máxima de 30 mg/semana. É recomendável a suplementação de ácido fólico como forma de prevenir efeitos adversos, especialmente os gastrointestinais e \r\nhematológicos; no entanto, há discordância quanto ao esquema de dose, sendo preconizada 5 mg/semana dois dias após a ingesta do metotrexato. Nos casos pediátricos o metotrexato é aprovado pelo FDA apenas para artrite reumatoide juvenil, porém pode ser utilizado em crianças na dose de 1,0-1,5 mg/kg/sem. Os \r\nprincipais efeitos adversos são hepatotoxicidade, intolerância gástrica e estomatite. Recomenda-se realizar monitorização conforme protocolo para adultos (7, 14). Não há estudos comparando a apresentação oral da injetável, mas sabe-se que a segunda reduz intolerância gástrica e tem melhor biodisponibilidade em doses \r\nelevadas, já que a administração de MTX por via oral pode ter absorção errática devido à saturação do mecanismo de transporte ativo de MTX no intestino. Por exemplo, a absorção de 17mg de MTX é 13,5% menor do que a da dose de 7,5mg. A via subcutânea cria uma espécie de atalho que aumenta a biodisponibilidade do fármaco. Desta forma, MTX injetável pode ser útil no tratamento de psoríase. Esta \r\nrecomendação desta via de administração, embasada fundamentalmente em opinião de especialistas, deve ser restrita aos casos de intolerância gástrica ou falha de resposta em que se suspeite de baixa absorção do fármaco pela via oral. Em virtude do exposto, solicita-se a ampliação da indicação do metotrexato injetável para o tratamento da psoríase - CID L40.0, L40.1, L40.4 e L40.8 - no Componente Especializado de Assistência Farmacêutica. Os membros da CONITEC presentes na 15ª reunião do plenário do dia 09/05/2013 recomendaram a ampliação de uso do metotrexato injetável para o tratamento de pacientes com psoríase em uso de MTX oral, com intolerância gástrica, conforme Protocolo Clínico e Diretrizes Terapêuticas (PCDT) a ser elaborado pelo Ministério da Saúde.