Influence of spironolactone on matrix metalloproteinase-2 in acute decompensated heart failure.

BACKGROUND: Matrix metalloproteinases (MMPs) are a family of enzymes important for the resorption of extracellular matrices, control of vascular remodeling and repair. Increased activity of MMP2 has been demonstrated in heart failure, and in acutely decompensated heart failure (ADHF) a decrease in circulating MMPs has been demonstrated along with successful treatment. OBJECTIVE: Our aim was to test the influence of spironolactone in MMP2 levels. METHODS: Secondary analysis of a prospective, interventional study including 100 patients with ADHF. Fifty patients were non-randomly assigned to spironolactone (100 mg/day) plus standard ADHF therapy (spironolactone group) or standard ADHF therapy alone (control group). RESULTS: Spironolactone group patients were younger and had lower creatinine and urea levels (all p < 0.05). Baseline MMP2, NT-pro BNP and weight did not differ between spironolactone and control groups. A trend towards a more pronounced decrease in MMP2 from baseline to day 3 was observed in the spironolactone group (-21 [-50 to 19] vs 1.5 [-26 to 38] ng/mL, p = 0.06). NT-pro BNP and weight also had a greater decrease in the spironolactone group. The proportion of patients with a decrease in MMP2 levels from baseline to day 3 was also likely to be greater in the spironolactone group (50% vs 66.7%), but without statistical significance. Correlations between MMP2, NT-pro BNP and weight variation were not statistically significant. CONCLUSION: MMP2 levels are increased in ADHF. Patients treated with spironolactone may have a greater reduction in MMP2 levels.

Influence of Spironolactone on Matrix Metalloproteinase-2 in Acute Decompensated Heart Failure / Influência da Espironolactona na Metaloproteinase de Matriz 2 na Insuficiência Cadíaca Aguda Descompensada

Background: Matrix metalloproteinases (MMPs) are a family of enzymes important for the resorption of extracellular matrices, control of vascular remodeling and repair. Increased activity of MMP2 has been demonstrated in heart failure, and in acutely decompensated heart failure (ADHF) a decrease in circulating MMPs has been demonstrated along with successful treatment. Objective: Our aim was to test the influence of spironolactone in MMP2 levels. Methods: Secondary analysis of a prospective, interventional study including 100 patients with ADHF. Fifty patients were non-randomly assigned to spironolactone (100 mg/day) plus standard ADHF therapy (spironolactone group) or standard ADHF therapy alone (control group). Results: Spironolactone group patients were younger and had lower creatinine and urea levels (all p < 0.05). Baseline MMP2, NT-pro BNP and weight did not differ between spironolactone and control groups. A trend towards a more pronounced decrease in MMP2 from baseline to day 3 was observed in the spironolactone group (-21 [-50 to 19] vs 1.5 [-26 to 38] ng/mL, p = 0.06). NT-pro BNP and weight also had a greater decrease in the spironolactone group. The proportion of patients with a decrease in MMP2 levels from baseline to day 3 was also likely to be greater in the spironolactone group (50% vs 66.7%), but without statistical significance. Correlations between MMP2, NT-pro BNP and weight variation were not statistically significant. Conclusion: MMP2 levels are increased in ADHF. Patients treated with spironolactone may have a greater reduction in MMP2 levels. .

Fundamento: As metaloproteinases de matriz (MMPs) constituem uma família de enzimas importantes para a reabsorção da matriz extracelular e controle do remodelamento e da reparação vasculares. Demonstrou-se aumento da atividade de MMP2 na insuficiência cardíaca, e, na insuficiência cardíaca agudamente descompensada (ICAD), demonstrou-se uma diminuição nas MMPs circulantes juntamente com o tratamento bem-sucedido. Objetivos: Testar a influência da espironolactona nos níveis de MMP2. Métodos: Análise secundária de estudo prospectivo, intervencionista, incluindo 100 pacientes com ICAD, 50 designados não aleatoriamente para o uso de espironolactona (100 mg/dia) mais terapia padrão para ICAD (grupo espironolactona) e 50 para terapia padrão para ICAD apenas (grupo controle). Resultados: Os pacientes do grupo espironolactona eram mais jovens e tinham níveis mais baixos de creatinina e ureia (todos p < 0,05). Os valores basais de MMP2, NT-pro BNP e peso não diferiram entre os grupos espironolactona e controle. Observou-se tendência para uma redução mais pronunciada na MMP2 do basal para o dia 3 no grupo espironolactona (-21 [-50 a 19] vs 1,5 [-26 a 38] ng/ml, p = 0,06). Os valores de NT-pro BNP e peso também apresentaram maior diminuição no grupo espironolactona. A proporção de pacientes com redução nos níveis de MMP2 do basal para o dia 3 também foi maior no grupo espironolactona (50% vs 66,7%), embora sem significado estatístico. As correlações entre as variações de MMP2, NT-pro BNP e peso não apresentaram significado estatístico. Conclusões: Os níveis de MMP2 acham-se aumentados na ICAD. Pacientes tratados com espironolactona podem apresentar maior redução nos níveis de MMP2. .

Presentación atípica de absceso retroperitoneal secundario a apendicitis aguda evolucionada / Atypical presentation of a retroperitoneal abscess secondary to a developed acute appendicitis

Secondary retroperitonitis after a developed acute appendicitis (without intraperitoneal involvement) is an unusually event. But otherwise manifested as inguinal tumoration, in a patient without previous inguinal hernia, is still less frequent. The fact that the retroperitoneal abscess founded the disection of the structures of the inguinal canal (without previous hermiation) by the retroperitoneal abscess simulating the clincal presentation of a strangulated inguinal hernia, supported to perform this presentation.

Diverticulitis cecal como causa de abdomen agudo quirúrgico. Presentación de un caso / Cecal diverticulitis as a cause of surgical acute abdomen

The unique cecal diverticulitis is a rare event in the occidental population with a difficult pre-surgical diagnosis. The observation of this entity encountered during the development of a laparoscopy because a supposed diagnosis of acute apendicitis, motivated this report.

Extrato metanólico da amêndoa da semente de nim e a mortalidade de ovos e lagartas da traça-do-tomateiro

A methanolic extract from neem seed kernels, obtained using the Soxhlet apparatus was used to study the mortality of eggs and larvae of Tuta absoluta (Lepidoptera: Gelechiidae) and to evaluate of the ovicidal effect. Eggs 24 hours after oviposition were counted and sprayed with the extract at the concentrations of 1000, 500, 250, 125 and 62.5 mg L-1. Controls were sprayed with water and methanol. The experiment was conducted in laboratory conditions at 25±2°C; UR 50±10% and 12 h of photophase. Incubation period for all treatments, including controls, was four days on the average. The extract did not affect the viability of eggs, although the values varied between of 51.7% the 80.6%. Larvae recently hatched from eggs were placed in glass tubes containing a tomato leaflet previously immersed for five seconds into the extract, at concentrations of 2000, 4000, 6000 and 8000 mg L-1 and conditioned on BOD at 27±1°C; 65±10% RH and 12 hours of light. By the fourth day after treatment the extract caused mortalities of 82, 68, 94.7 and 100%, respectively. By the sixth day, all concentrations caused 100% mortality of the larvae. The controls with water and methanol presented mortalities of 4 and 8%, respectively.

Estudou-se o efeito tóxico do extrato metanólico da amêndoa da semente de nim, obtido pelo aparelho de Soxhlet, na mortalidade de ovos e lagartas de Tuta absoluta (Meyrick) (Lepidoptera: Gelechiidae). Para constatação do efeito ovicida, ovos com 24 horas da oviposição foram contados e pulverizados com extrato nas concentrações 1000; 500; 250; 125 e 62,5 mg L-1. As testemunhas foram pulverizadas com água e metanol. O experimento foi mantido, em laboratório, a 25 ± 2°C; UR de 50 ± 10% e fotofase de 12 h. O período de incubação, para todos os tratamentos inclusive as testemunhas, foi em média de quatro dias, sendo que o extrato não afetou a viabilidade dos ovos, embora os valores tenham variado de 51,7% a 80,6%. Lagartas recém-eclodidas foram colocadas em tubos contendo um folíolo de tomateiro, previamente imerso em extrato, nas concentrações de 2000; 4000; 6000 e 8000 mg L-1 e acondicionados na câmara climatizada à 27 ± 1°C; UR: 65 ± 10% e fotofase: 12 h. Aos quatro dias, causaram mortalidade de 82, 68, 94,7 e 100%, respectivamente, sendo que, ao sexto dia, todas as concentrações tinham causado 100% de mortalidade da fase larval. As testemunhas tratadas com água e com metanol apresentaram mortalidade de 4% e 8%, respectivamente.

Extrato metanólico da amêndoa da semente de nim e a mortalidade de ovos e lagartas da traça-do-tomateiro

A methanolic extract from neem seed kernels, obtained using the Soxhlet apparatus was used to study the mortality of eggs and larvae of Tuta absoluta (Lepidoptera: Gelechiidae) and to evaluate of the ovicidal effect. Eggs 24 hours after oviposition were counted and sprayed with the extract at the concentrations of 1000, 500, 250, 125 and 62.5 mg L-1. Controls were sprayed with water and methanol. The experiment was conducted in laboratory conditions at 25±2°C; UR 50±10% and 12 h of photophase. Incubation period for all treatments, including controls, was four days on the average. The extract did not affect the viability of eggs, although the values varied between of 51.7% the 80.6%. Larvae recently hatched from eggs were placed in glass tubes containing a tomato leaflet previously immersed for five seconds into the extract, at concentrations of 2000, 4000, 6000 and 8000 mg L-1 and conditioned on BOD at 27±1°C; 65±10% RH and 12 hours of light. By the fourth day after treatment the extract caused mortalities of 82, 68, 94.7 and 100%, respectively. By the sixth day, all concentrations caused 100% mortality of the larvae. The controls with water and methanol presented mortalities of 4 and 8%, respectively.

Estudou-se o efeito tóxico do extrato metanólico da amêndoa da semente de nim, obtido pelo aparelho de Soxhlet, na mortalidade de ovos e lagartas de Tuta absoluta (Meyrick) (Lepidoptera: Gelechiidae). Para constatação do efeito ovicida, ovos com 24 horas da oviposição foram contados e pulverizados com extrato nas concentrações 1000; 500; 250; 125 e 62,5 mg L-1. As testemunhas foram pulverizadas com água e metanol. O experimento foi mantido, em laboratório, a 25 ± 2°C; UR de 50 ± 10% e fotofase de 12 h. O período de incubação, para todos os tratamentos inclusive as testemunhas, foi em média de quatro dias, sendo que o extrato não afetou a viabilidade dos ovos, embora os valores tenham variado de 51,7% a 80,6%. Lagartas recém-eclodidas foram colocadas em tubos contendo um folíolo de tomateiro, previamente imerso em extrato, nas concentrações de 2000; 4000; 6000 e 8000 mg L-1 e acondicionados na câmara climatizada à 27 ± 1°C; UR: 65 ± 10% e fotofase: 12 h. Aos quatro dias, causaram mortalidade de 82, 68, 94,7 e 100%, respectivamente, sendo que, ao sexto dia, todas as concentrações tinham causado 100% de mortalidade da fase larval. As testemunhas tratadas com água e com metanol apresentaram mortalidade de 4% e 8%, respectivamente.