Suplementación con bromelina en el daño muscular producido durante el ejercicio físico excéntrico. Estudio Bromesport / Bromelain supplementation on muscle damage produced during the eccentric exercise. Bromesport study

Introducción: Este estudio examina los efectos de la suplementación con bromelina sobre marcadores de daño muscular anátomoestructurales (edema intersticial), biológicos y funcionales de fuerza, provocado mediante un ejercicio físico con componente excéntrico, intensificado en algunos grupos con una suplementación de oclusión vascular. El objetivo es evaluar si la bromelina es útil para disminuir la clínica asociada con el DOMS y facilitar la recuperación de la fuerza muscular tras un trabajo excéntrico. Material y métodos: Estudio piloto, diseño cuasi-experimental multicéntrico, aleatorio, a doble ciego, paralelo, controlado con placebo. Se seleccionaron voluntarios sanos varones, repartidos aleatoriamente en los siguientes grupos: Sin oclusión Suplementado con Bromelina (GES), y Placebo (GEP), con Oclusión Suplementado con Bromelina (GEOS) y Placebo (GEOP). En todos los sujetos se evaluó el dolor muscular, fuerza explosiva (squat jump y counter movement jump), signos biológicos de citolisis (creatin fosfo-quinasa, lactato-deshidrogenasa y creatinina), y edema intersticial global y segmentario. Los tests se realizaron justo antes (T1), inmediatamente después del ejercicio excéntrico (T2), a las 24h (T3), 48h (T4) y 72h (T5).Los sujetos del grupo suplementado recibieron extracto de 50 mg, Rottapharm, SL), (100 mg, 30 minutos previos a la realización del ejercicio y 50 mg al finalizar la sesión), mientras que el otro grupo, recibió placebo, ambos en forma de comprimidos. Resultados y conclusiones: Se analizaron 45 varones sanos de edad (20,49±1,70). La suplementación con bromelina es eficaz para disminuir el dolor asociado al DOMS en todas las fases, especialmente a las 48 horas post-lesión favoreciendo una disminución más rápida del dolor. Previene y neutraliza el edema intramuscular agudo producido en la realización de un ejercicio con componente excéntrico. Disminuye la pérdida precoz de la fuerza explosiva elástica tras la realización de un trabajo excéntrico acelerando la reparación tisular tras la lesión. Estos resultados demuestran que la suplementación con bromelina previene la citolisis precoz, favoreciendo así la regeneración en fases muy tempranas de la lesión muscular y manteniendo su efecto en la fase inflamatoria de la lesión. Todo esto permite mejorar la recuperación muscular y disminuir las lesiones relacionadas con el trabajo físico con componente excéntrico (AU)

Introduction: This study examines the effects of bromelain supplementation on anatomical-structural (interstitial edema), biological and functional features of strength markers of muscle damage, caused by physical exercise with eccentric component, intensified in some groups with a supplementation of vascular occlusion. The objective is to assess whether bromelain is helpful to reduce the clinic associated with DOMS and facilitate the recovery of muscles trength after eccentric work. Material and methods: A pilot study, quasi-experimental multicenter, randomized, double-blind, parallel, placebo controlled trial. We selected healthy male volunteers, randomly divided into the following groups: No occlusion Supplemented with bromelain (GES) and Placebo (GEP), with occlusion Supplemented with bromelain(GEOS) and Placebo (GEOP). In all subjects was assessed muscle pain, explosive strength (squat jump and counter movement jump), biological signs of cytolysis (creatinfosfo kinase, lactate dehydrogenase and creatinine), and global and segmental interstitial edema. The tests were performed just before (T1), immediately after eccentric exercise (T2), at 24h (T3), 48h (T4) and 72 h (T5). Subjects in the supplemented group received bromelain extract (50mg Fortilase, Rottapharm, SL), (100 mg, 30 minuts prior to exercise and 50 mg at the end of the session), while the other group received placebo, both in the form of tablets. Results and conclusions: Forty-four healthy older men (20.49±1.70) were analyzed. The supplementation with bromelain is effective in reducing the pain associated with DOMS at all stages, especially at 48 hours post-injury favoring a faster decrease in pain. Prevents and neutralizes acute intramuscular edema occurred in the execution of an eccentric exercise component. Decreases the loss of explosive strength after the completion of a job eccentric work accelerating tissue repair after the injury. These results demonstrate that bromelain supplementation preventsearly cytolysis, thus promoting regeneration in very early stages of muscle injury and maintaining its effect in the inflammatory phase of injury. All this allows to improve muscle recovery and reduce injuries related to physical work with eccentric component (AU)

Safety and efficacy of tirofiban as adjunctive therapy for patients with ST-elevation myocardial infarction: a comparison versus placebo and abciximab.

Tirofiban is a nonpeptide tyrosine derivative that together with eptifibatide (both small molecules) and abciximam belongs to the group of glycoprotein IIb/IIIa inhibitors. Though similar to abciximab in that it has a high affinity for the GP IIbIIIa inhibitor receptor, tirofiban dissociates from it much faster tan abciximab, what makes its action reversible in a few hours. Initially used upstream for treatment of patients with non ST-elevation acute coronary síndromes, recent evidence has shown its role as adjuntive therapy in patients with ST-elevation acute myocardial infarction treated with primary angioplasty when used at a higher dose. In this article, we performed a thorough and systematic review of randomized trials comparing tirofiban versus pacebo and tirofiban versus abciximab when used in this subset of patients. All these studies showed tirofiban to be a well tolerated and effective IIbIIIa inhibitor. When compared with placebo, tirofiban was associated with a significant reduction in mortality and myocardial infarction at one month, with a higher risk of minor bleeding in the follow-up. When compared with abciximab, tirofiban showed no difference in mortality and a tendency to higher rate of the composite of death and myocardial infarction in the short term follow-up that disappeared when only studies with high-dose tirofiban were considered. On the basis of the high-dose regimen, tirofiban may be considered useful in the management of patients with ST-elevation myocardial infarction who undergo primary angioplasty.