Utilization Patterns and Trends in the Use of Medications for Asthma in a Cohort of Colombian Patients.

Purpose: Asthma affects approximately 358 million people worldwide. This study aimed to determine the trend for the use of medications intended to treat asthma in a group of patients affiliated with the Colombian health system. Patients and Methods: This was a retrospective study on prescription patterns of medications used to treat asthma in patients over 5 years of age between 2017 and 2019. Sociodemographic variables, medications used and combinations, the persistence of use, and prescribing physicians were considered. Data were obtained from a drug-dispensing database from Colombia. Results: A total of 10,706 people diagnosed with asthma were identified, including predominantly females (56.8%), with a mean age of 32.2 ± 26.1 years. At the beginning of the follow-up, 53.2% of patients aged 5-11 years were receiving monotherapy, with a mean of 1.5 ± 0.6 drugs/patient, especially inhaled corticosteroids (ICSs; 55.9%) and short-acting ß-agonists (SABAs; 55.6%). Moreover, in patients older than 12 years, 53.5% were treated with monotherapy, with a mean of 1.6 ± 0.7 drugs/patient, 45.9% of whom were on SABAs, while 37.1% were on ICSs. Between 63.0% and 83.6% of patients were treated by a general practitioner. 12.5% of patients (n = 495) received triple therapy (ICS/LABA + LAMA [long-acting antimuscarinic]), particularly fluticasone/salmeterol + tiotropium. Conclusion: The identification of treatment patterns will allow physicians and decision makers to implement strategies in order to promote adherence to treatment and improve asthma medication use.

Effectiveness of Spacer Devices on Preventing Undesirable Cardiovascular Effects of Inhaled Salbutamol.

Background: Currently, there are no regulatory guidelines indicating spacer devices/valved holding chamber (VHC) should be used routinely during pulmonary function tests, and few studies evaluated if spacer devices reduce beta-agonist bronchodilators' side effects. Methods: A prospective study compared salbutamol's cardiovascular effects and bronchodilation response during spirometry tests with and without a spacer device/VHC. Heart rate (HR), the corrected QT interval (QTc), and systolic and diastolic blood pressure were measured 10 minutes after the first spirometry test, before the drug administration, and 20 minutes after inhalation in both groups. Spirometric parameters (forced expiratory volume in the first second [FEV1], forced vital capacity [FVC], and FEV1/FVC) were also measured for both groups. Results: HR and QTc increase were significantly higher in the pressurized meter dose inhalers alone group versus the VHC group [mean SD] [73.1 ± 10 bpm to 74.3 + 10 bpm, p = 0.021] and [median (25%-75% interquartile range)] [389 ms (381-404) to 398 ms (387-407), p = 0.045] vs. [mean SD] [75.4 ± 9 to 73.8 + 8 bpm, p = 0.4] and [median (25%-75% interquartile range)] [388 ms (347-408) to 385 ms (366-408), p = 0.35], respectively. FEV1 variation before and after salbutamol were similar between both groups. Discussion: Although VHC significantly reduces HR and QTc variation when using beta-agonist bronchodilators in healthy patients, no clinical repercussions of this variation were found in this study, since no event of tachycardia or pathological QTc was recorded. Conclusion: VHC has a diminished clinical impact for healthy patients when considering cardiovascular effects and spirometric parameters. Beta-agonist bronchodilators may be administrated despite the use of spacer devices in patients without known cardiovascular diseases. Its significance for other populations still needs to be determined.

Severe hypokalemia secondary to abuse of ß-adrenergic agonists in a pediatric patient: Case report / Hipocalemia grave secundária a abuso de agonistas ß-adrenérgicos em paciente pediátrico: relato de caso

ABSTRACT This study reports a case of a 13-year-old male with a 3-year history of severe and intermittent hypokalemia episodes of unknown origin, requiring admission to the intensive care unit (ICU) for long QT syndrome (LQTS), finally diagnosed of redistributive hypokalemia secondary to the abuse of β-adrenergic agonists in the context of a probable factitious disorder.

RESUMO O presente estudo relata o caso de um jovem de 13 anos de idade com histórico, há três anos, de episódios de hipocalemia grave intermitente de origem desconhecida, internado em unidade de terapia intensiva (UTI) por síndrome do QT longo (SQTL). O paciente foi diagnosticado com hipocalemia por redistribuição secundária ao abuso de agonistas β-adrenérgicos, em contexto de provável transtorno factício.

Conduta terapêutica em pacientes com doença pulmonar obstrutiva crônica: monoterapia ou terapia cominada? / Therapy for chronic obstructive pulmonary disease patients: monotherapy or combination therapy?

Objetivo: Comparar a dupla terapia broncodilatadora com glicopirrônio mais indacaterol à monoterapia com glicopirrônio em pacientes portadores de doença pulmonar obstrutiva crônica. Métodos: Estudo clínico prospectivo, unicêntrico, controlado, cruzado, randomizado e duplo-cego realizado com 14 pacientes com diagnóstico de doença pulmonar obstrutiva crônica grau II. Os participantes receberam cada um dos tratamentos durante 30 dias. Antes de cada terapia, realizou-se período de wash-out por 7 dias, com broncodilador de curta ação. Antes e após cada intervenção, os pacientes passaram por exame de espirometria e responderam ao questionário COPD Assessment Test. Resultados: Observou-se melhora na função pulmonar medida por meio do volume expiratório forçado no primeiro segundo de 19mL (±36) para a monoterapia e 87mL (±33) para a terapia dupla. O ganho foi de 67mL (p=0,042) da associação dos medicamentos em relação ao glicopirrônio isolado. A melhora na qualidade de vida, medida a partir das pontuações do questionário, foi de 4,7 (±8,9) pontos para a monoterapia e 5,2 (±11) pontos para a dupla terapia (p=0,08). Conclusão: Ambos os tratamentos demonstram melhora na função pulmonar dos pacientes.

Objective: To compare dual bronchodilator therapy (Glycopyrronium with Indacaterol) versus Glycopyrronium monotherapy in patients with chronic obstructive pulmonary disease. Methods: This was a prospective, unicentric, controlled, crossover, randomized, and double-blind clinical trial with 14 patients diagnosed with grade II chronic obstructive pulmonary disease. The participants received each treatment during the period of 30 days. Before each therapy, a 7-day wash-out period with a short-acting bronchodilator was instituted. Before and after each intervention, the patients underwent spirometry and answered the COPD Assessment Test questionnaire. Results: An improvement in pulmonary function measured by forced expiratory volume during the first second of 19mL (±36) for monotherapy, and 87mL (±33) for dual therapy was observed. The gain was of 67mL (p=0.042) in the association of the drugs in relation to Glycopyrronium alone. The mean improvement in quality of life measured from the questionnaire scores was 4.7 (±8.9) points for monotherapy and 5.2 (± 11) points for dual therapy (p=0.08). Conclusion: Both treatments show improvement in the patients' pulmonary function.

Long-acting muscarinic antagonists vs. long-acting β 2 agonists in COPD exacerbations: a systematic review and meta-analysis / Antagonistas muscarínicos de longa duração vs. β 2 -agonistas de longa duração em exacerbações da DPOC: revisão sistemática e meta-análise

ABSTRACT Objective: To determine whether long-acting muscarinic antagonists (LAMAs) provide superior therapeutic effects over long-acting β2 agonists (LABAs) for preventing COPD exacerbations. Methods: This was a systematic review and meta-analysis of randomized clinical trials involving patients with stable, moderate to severe COPD according to the Global Initiative for Chronic Obstructive Lung Disease criteria, treated with a LAMA (i.e., tiotropium bromide, aclidinium, or glycopyrronium), followed for at least 12 weeks and compared with controls using a LABA in isolation or in combination with a corticosteroid. Results: A total of 2,622 studies were analyzed for possible inclusion on the basis of their title and abstract; 9 studies (17,120 participants) were included in the analysis. In comparison with LABAs, LAMAs led to a greater decrease in the exacerbation rate ratio (relative risk [RR] = 0.88; 95% CI: 0.84-0.93]; a lower proportion of patients who experienced at least one exacerbation (RR = 0.90; 95% CI: 0.87-0.94; p < 0.00001); a lower risk of exacerbation-related hospitalizations (RR = 0.78; 95% CI: 0.69-0.87; p < 0.0001); and a lower number of serious adverse events (RR = 0.81; 95% CI: 0.67-0.96; p = 0.0002). The overall quality of evidence was moderate for all outcomes. Conclusions: The major findings of this systematic review and meta-analysis were that LAMAs significantly reduced the exacerbation rate (exacerbation episodes/year), as well as the number of exacerbation episodes, of hospitalizations, and of serious adverse events.

RESUMO Objetivo: Determinar se long-acting muscarinic antagonists (LAMAs, antagonistas muscarínicos de longa duração) são superiores a long-acting β2 agonists (LABAs, β2-agonistas de longa duração) na prevenção de exacerbações da DPOC. Métodos: Revisão sistemática e meta-análise de ensaios clínicos controlados aleatórios com pacientes com DPOC estável, de moderada a grave, conforme os critérios da Global Initiative for Chronic Obstructive Lung Disease, tratados com LAMA (brometo de tiotrópio, aclidínio ou glicopirrônio), acompanhados durante pelo menos 12 semanas e comparados a controles que usaram LABA isoladamente ou com um corticosteroide. Resultados: Foram analisados 2.622 estudos para possível inclusão com base em seu título e resumo; 9 estudos (17.120 participantes) foram incluídos na análise. Em comparação com LABAs, LAMAs resultaram em maior diminuição da razão da taxa de exacerbações [risco relativo (RR) = 0,88; IC95%: 0,84-0,93]; menor proporção de pacientes que apresentaram pelo menos uma exacerbação (RR = 0,90; IC95%: 0,87-0,94; p < 0,00001); menor risco de hospitalizações em virtude de exacerbação da doença (RR = 0,78; IC95%: 0,69-0,87; p < 0,0001) e menor número de eventos adversos sérios (RR = 0,81; IC95%: 0,67-0,96; p = 0,0002). A qualidade geral das evidências foi moderada para todos os desfechos. Conclusões: O principal achado desta revisão sistemática e meta-análise foi que LAMAs reduziram significativamente a taxa de exacerbações (episódios de exacerbação/ano), os episódios de exacerbação, as hospitalizações e os eventos adversos sérios.

Effects of catecholamines on volemic replacement with saline solution and the impact on heart rate variability in rabbits subjected to hemorrhage. A study by spectral analysis

PURPOSE: To verify the effects of different catecholamines on volemic expansion and on the autonomic nervous system in rabbits that were subjected to hemorrhage. METHODS: Twenty four rabbits subjected to hemorrhage (with a 25% loss of blood volume) and were randomly divided into four experimental groups: 1) HEMO Group underwent replacement with their own blood in an equal volume; 2) SS Group underwent replacement with saline solution (SS) in a volume that corresponded to three times the removed blood volume; 3) ISP Group underwent replacement with SS and isoprenaline; 4) FNL Group underwent replacement with SS and phenylephrine. Spectral Analysis of the heart rate and heart rate variability were performed from the recorded data. Hematocrit was measured throughout the experiment. RESULTS: Replacement with SS and an α- or β-agonist did not produce differences in the intravascular retention compared to replacement with SS alone. An analysis of HRV showed that the FNL group maintained the LF/HF ratio better than ISP and SS. CONCLUSIONS: No difference in vascular retention when α- or β- agonists were added to SS during post-hemorrhagic recovery. The animals in the FNL group maintained the integrity of the autonomic response within normal physiological standards during hemorrhagic stress. .

Effects of catecholamines on volemic replacement with saline solution and the impact on heart rate variability in rabbits subjected to hemorrhage. A study by spectral analysis

Twenty four rabbits subjected to hemorrhage (with a 25% loss of blood volume) and were randomly divided into four experimental groups: 1) HEMO Group underwent replacement with their own blood in an equal volume; 2) SS Group underwent replacement with saline solution (SS) in a volume that corresponded to three times the removed blood volume; 3) ISP Group underwent replacement with SS and isoprenaline; 4) FNL Group underwent replacement with SS and phenylephrine. Spectral Analysis of the heart rate and heart rate variability were performed from the recorded data. Hematocrit was measured throughout the experiment.RESULTS:Replacement with SS and an α- or β-agonist did not produce differences in the intravascular retention compared to replacement with SS alone. An analysis of HRV showed that the FNL group maintained the LF/HF ratio better than ISP and SS.CONCLUSIONS:No difference in vascular retention when α- or β- agonists were added to SS during post-hemorrhagic recovery. The animals in the FNL group maintained the integrity of the autonomic response within normal physiological standards during hemorrhagic stress.(AU)

Comparative study of nitric oxide production induced by selective estrogen receptors alpha and beta agonists in rats / Comparação da produção de óxido nítrico mediada por agonistas seletivos de receptores estrogênicos alfa e beta em ratos

BACKGROUND AND OBJECTIVES: Nitric oxide (NO) is a potent vasodilator and estrogen-mediated vasodilation that increases NO production. The association of the vascular endothelium, gender and vasodilation induced by estrogen is due to the activation of two estrogen receptors, alpha (ERa) and beta (ERb). The aim of this study was to compare NO production stimulating receptors ERa and ERb with the use of selective agonists in thoracic aortas of rats. METHODS: Aortic rings were either treated with 17 ?-estradiol (17-BE2); acetylcholine (Ach); 4,4',4-[4-propil-(1H)-pirazol-1,3,5-triyl]tris-phenol (PPT), and 2,3-Bis(4-hydroxyphenyl)-propionitrile (DPN), or left untreated, and the concentration of NO was determined by spectrophotometry method. RESULTS: The females presented a higher basal concentration of nitrite than males. PPT determined increased production of nitrite in both females and males, compared to17-beta-estradiol (17-BE2). In males, the production of nitrite induced by DPN and PPT was higher than that induced by 17-BE2. The stimulation with 17-BE2 increased the production of nitrite in females compared to males. Regardless the gender, the stimulation of aortic rings by PPT caused a greater production of nitrite compared to that induced by 17-BE2. Interestingly, the stimulation of aortic rings from males with DPN provided an increase in the nitrite production compared to the levels induced by 17-BE2 incubation. CONCLUSION: The stimulation of estrogen receptor (ER) by PPT provides greater production of nitrite than 17-BE2 regardless of gender; in males, the stimulation of ER by DPN provides bigger production of nitrite than 17-BE2; the basal production of nitrite is higher in females compared to males.

JUSTIFICATIVA E OBJETIVOS: O óxido nítrico (NO) é um potente vasodilatador e o estrógeno promove vasodilatação aumentando a produção de NO. A associação entre endotélio vascular, gênero e vasodilatação induzida pelo estrógeno, é pela ativação de receptores estrogênicos, alfa (ERa) e (beta) ERb.O objetivo deste estudo foi comparar a produção de NO estimulando receptores estrogênicos, ERa e ERb, por agonistas seletivos em aorta torácica de ratos. MÉTODOS: Anéis aórticos foram tratados com 17 ?-estradiol (17-BE2), acetilcolina (Ach), 4,4',4-[4-propil-(1H)-pirazol-1,3,5-triyl]tris-fenol (PPT) e 2,3-Bis(4-hidroxifenil)-propionitrila (DPN) ou não tratados e a determinação de NO foi feita por método espectrofotométrico. RESULTADOS: As fêmeas apresentaram produção constitutiva basal de nitrito mais elevada do que os machos. O PPT causou elevação na produção de nitrito em ambos os sexos, em relação ao observado com 17-beta estradiol (17-BE2). Nos machos, PPT e DPN, aumentaram a produção de nitrito comparada àquela induzida por 17-BE2.A estimulação com 17-BE2 causou maior produção de nitrito em fêmeas que em machos. A incubação com PPT determinou maior produção de nitrito comparada àquela induzida por 17-BE2, independente do gênero. Interessantemente, em machos,a estimulação das artérias com DPN acarretou em elevação na produção de nitrito comparada ao efeito causado por 17-BE2.CONCLUSÃO: A estimulação de receptor estrogênico (ER) pelo PPT determina maior produção de nitrito do que 17-BE2 independente do gênero; a estimulação de ER pelo DPN determina maior produção de nitrito do que 17-BE2 em machos; a produção basal de nitrito é mais elevada em fêmeas comparada aos machos.

Há evidências favorecendo o uso de betabloqueadores e dobutamina na insuficiência cardíaca aguda? / Is there evidence favoring the use of beta-blockers and dobutamine in acute heart failure?

Diversos estudos relataram os benefícios dos betabloqueadores (BB) para pacientes com insuficiência cardíaca sistólica. No entanto, muitos pacientes hospitalizados em decorrência de insuficiência cardíaca aguda já estão usando os BB e requerem dobutaminas para hipotensão arterial e baixo débito cardíaco. Portanto, deve-se tomar uma decisão a respeito de se o BB deve ser mantido ou até mesmo iniciado nesses casos. O objetivo deste estudo foi determinar se há provas que sustentem a segurança e a eficácia dos BB junto com a dobutamina para pacientes com insuficiência cardíaca aguda descompensada (ICAD). Foi realizada uma pesquisa na literatura de língua inglesa nas bases de dados MEDLINE, ISI Web of Science, Biblioteca Virtual em Saúde, Cochrane Library e o Portal de Revistas Científicas do Capes para identificar estudos relacionados. Literatura adicional foi obtida mediante a análise das respectivas referências encontradas nos artigos identificados. Os resultados esperados incluíram informações sobre o prognóstico (intra-hospitalar e na mortalidade no acompanhamento, número de dias de internação e reinternação), eficácia e segurança (agravamento dos sintomas, choque, intolerância) do uso concomitante desses medicamentos em pacientes hospitalizados com ICAD e baixo débito cardíaco. Esta análise incluiu nove estudos. No entanto, não foram encontrados ensaios clínicos randomizados sobre o assunto. A maioria dos estudos inclui baixo número de pacientes, e não foram encontrados estudos que abordem a segurança do uso concomitante desses medicamentos. Os dados resultantes sugerem que uma cuidadosa revisão da literatura não forneceu evidências para o uso sistemático de BB em pacientes com síndrome de baixo débito cardíaco que necessitam de suporte inotrópico com dobutamina.

Several studies have reported the benefits of beta-blockers (BB) for patients presenting with systolic heart failure. however, many patients hospitalized as a result of acute heart failure are already using BB and require dobutamine for arterial hypotension and low cardiac output. Therefore, a decision must be made regarding whether BB should be maintained or even started in such cases. The aim of this study was to establish whether there is evidence supporting the safety andyeffectiveness of BB together with dobutamine for patients presenting with acute decompensated heart failure (ADHF). We conducted a search of the English-language literature in the databases MEDLINE, ISI Web of Science, Virtual Health Library, Cochrane Library and the CAPES Portal of Scientific Journals to identify related studies. Additional literature was obtained through the review of relevant references in the identified articles. The expected outcomes included information on the prognosis (in-hospital and on follow-up mortality, number of days of hospitalization and readmission),yeffectiveness and safety (worsening of symptoms, shock, intolerance) of the concomitant use of these drugs in hospitalized patients with ADHF and low cardiac output. This review included nine studies. however, no randomized clinical trials on this subject were found. Most studies include a low number of patients, and no studies addressing the safety of the concomitant use of these drugs were found. The resulting data suggest that a careful literature review did not supply evidence for the systematic use of BB in patients with low cardiac output syndrome who require dobutamine for inotropic support.

Aceptación del uso de aerocámaras / Acceptance of the use of holding chambers

Objetivo: Obtener una aproximación objetiva de la aceptabilidad de los aerosoles de salbutamol por las madres de los pacientes con sibilancias o asma. Metodología: Estudio descriptivo, observacional, realizado con encuestas aplicadas a madres de pacientes que están usando o han usado salbutamol como tratamiento broncodilatador. La encuesta se realizó desde el 1 de julio al 31 de agosto de 2010 a pacientes que acudieron al consultorio. Se analizaron los datos con el programa EPI- Info 2002. Resultados: Respondieron a la encuesta 102 madres de pacientes, el rango de edad de los niños fue: 0 a 11 años y la media de 3 años. Usó salbutamol en aerosol: 79,4% de los pacientes, jarabe: 65,7 % y nebulizaciones: 72,5%. Cuál le parece mejor: 72% salbutamol en aerosol en aerocámara; 19% en jarabe y el 9% en las nebulizaciones. Alguien le dijo que el aerosol produce adicción: 40,6% y le dijo un vecino en el 50%, un familiar 12,5%, una enfermera 10,4%, un pediatra 8,3% y un médico general 15,7%. Cree que produce adicción: Sí 12,9%. Recomendaría el uso de aerocámaras el 76,8% de las encuestadas. Conclusión: Hay un porcentaje mayor de encuestadas que acepta la utilización del aerosol como mejor forma de usar el salbutamol, sin embargo hay un 28 % que no acepta los aerosoles. Un respetable número de pacientes (34,4%) refieren ser desaconsejadas en el uso de la aerosolterapia por profesionales sanitarios. El jarabe goza de una cierta aceptación, argumentando mayor aprobación por el niño y mayor efectividad. Pesa mucho la creencia popular en la forma de administrar el salbutamol, lo cual resalta la disrelación entre la evidencia científica y la aceptación del paciente o de su madre y del profesional sanitario que aplica el tratamiento broncodilatador con salbutamol.

Introduction: The latest recommendations of scientific publications, the Global Initiative for Asthma (GINA), and European consensus all agree that the best way to administer salbutamol is as an aerosol due to its effectiveness, more direct action, greater convenience, and reduced side effects. However, not all patients, including some health professionals, accept their use due to cultural reasons, beliefs, or due to being out of date or reluctant to try innovations. What is recommended by science is not always accepted and incorporated into daily practice by patients or healthcare professionals. Objective: To obtain an objective estimate of the acceptability of aerosol salbutamol by the mothers of patients with wheezing or asthma. Methodology: A descriptive observational study carried out by surveying mothers of patients who are using or who have used salbutamol as a bronchodilator. The survey was carried out between July 1 and August 31, 2010 on patients attending the clinic. Results: The survey was completed by 102 mothers of patients, with children ranging from age 0 to 11 years with a mean age of 3 years. Salbutamol was used as aerosol by 79.4% of patients, as syrup by 65.7%, and in a mist by 72.5%. Asked which seems better, 72% cited salbutamol aerosol with a holding chamber, 19% syrup, and 9% the mists. Asked if someone had told them the aerosol causes addiction, 40.6% said someone had, with 50% citing a neighbor, 12.5% a relative, 10.4% a nurse, 8.3% a pediatrician, and 15.7% a general practitioner. Asked if they believe it causes addiction, 12.9% said they did, and 76.8% said they would recommend the use of holding chambers. Conclusion: A majority of respondents accepts the use of aerosol as the best way to administer salbutamol, while 28% do not accept aerosols. A notable number of mothers (34.4%) reported being discouraged from the use of aerosol by health professionals...

Tratamiento farmacológico para el control del asma en el niño

El presente artículo presenta las recomendaciones de un grupo de expertos venezolanos reunidos en Caracas en Octubre de 2009 por la Sociedad Venezolana de Puericultura y Pediatría en relación al tratamiento farmacológico del asma infantil. Se presentan los objetivos del tratamiento, los medicamentos recomendados, la terapia inicial y de mantenimiento y el tipo de dispositivo para la administración de drogas por vía inhalatoria, de acuerdo a la edad del paciente.

This article presents the recommendations made by a group of Venezuelan experts during a consensus meeting held in Caracas in October, 2009, under the auspices of the Venezuelan Society of Pediatrics, on the pharmacological treatment of childhood asthma. Goals of treatment, recommended medications, initial and maintenance therapy, and devices utilized for delivery of inhaled drugs according to patient’s age are presented.

Ractopamina em dietas para suínos machos imunocastrados, castrados e fêmeas / Ractopamine in diets for immunocastrated, barrows and females

O objetivo do trabalho foi avaliar o desempenho e as características quantitativas de carcaça de suínos machos imunocastrados, castrados e fêmeas, na fase de terminação, alimentados com dietas contendo 10ppm de ractopamina. Foram utilizados 120 animais, com peso inicial de 99,1±5,3kg, distribuídos em delineamento de blocos ao acaso, em esquema fatorial 2 x 3 (dois níveis de ractopamina, 0 e 10ppm e três sexos), cinco repetições com quatro animais cada. A inclusão de 10ppm de ractopamina na dieta melhorou (P<0,05) a conversão alimentar dos suínos, independentemente do sexo. A inclusão de ractopamina prejudicou (P<0,05) o ganho de peso dos machos imunocastrados e aumentou (P<0,05) o ganho de peso dos machos castrados e das fêmeas, sem, no entanto, afetar (P>0,05) as características quantitativas de carcaça dos suínos. O sexo foi determinante para o desempenho e as características quantitativas de carcaça; as fêmeas apresentaram rendimento de carcaça quente superior (P<0,05) aos machos imunocastrados, que apresentaram rendimento superior (P<0,05) aos machos castrados. Os machos imunocastrados e as fêmeas apresentaram maior (P<0,05) percentual de carne magra em relação aos machos castrados. Os resultados desta pesquisa evidenciam a necessidade de estudos visando à adequação dos níveis nutricionais das dietas contendo ractopamina para suínos imunocastrados.

The objective of this study was to evaluate the performance and the quantitative characteristics of carcass of immunocastrated, barrows and females in the finishing phase fed with diets containing 10ppm of ractopamine. One hundred and twenty animals were used, with initial weight of 99.1±5.3kg, distributed in a randomized blocks factorial design in 2 x 3 (two ractopamine levels, 0 and 10ppm and three sex), five replicates of four animals each. The inclusion of 10ppm of ractopamine in the diet improved (P<0.05) feed conversion in pigs, independent of sex. The inclusion of ractopamine damaged (P<0.05) the weight gain of the immunocastrated and increased (P<0.05) the weight gain of the barrows and the females, without, however, affect (P>0.05) quantitative carcass characteristics of pigs. The sex was determining factor in performance and carcass quantitative traits and the females had higher (P<0.05) hot carcass yield for immunocastrated male and they have yield above (P<0.05) the barrows. Immunocastrated males and females had higher (P<0.05) percentage of lean meat for barrows. The results of this study highlight the need for studies to adjust the nutrient levels of diets containing ractopamine to immunocastrated pigs.

Terapia de resgate com amiodarona em crianças com grave disfunção ventricular esquerda causada por veneno de escorpião / Antiadrenergic rescue therapy with amiodarone in children with severe left ventricular dysfunction secondary to scorpion envenomation / Terapia de rescate con amiodarona en niños con severa disfunción ventricular izquierda ocasionada por veneno de escorpión

Fundamentos: As crianças picadas por escorpião, pressintam ativação maciça do sistema nervoso simpática com vários graus de disfunção sistólica ventricular esquerda. Oobjetivo: Testar um protocolo de resgate em crianças com grave disfunção ventricular esquerda causada por picada de escorpião. Métodos: Quatro crianças após serem picadas por escorpião foram submetidas a: Encubação endotraqueal e suporte respiratório, eletrocardiograma, radiografia de tórax, ecocardiograma e determinação sérica da norepinefrina e troponina I. As análises foram repetidas após 12, 24 e 48 horas. As seguintes medicações intravenosas foram administradas: dobutamina 4-6 μg/kg/min; amiodarona 3 mg/kg durante duas horas, com dose de manutenção de 5 mg/kg/dia; e furosemida 0,5 mg/kg. Amiodarona, dobutamina e furosemida foram administradas durante as primeiras 48 horas. Bloqueadores beta-adrenérgicos e inibidores da enzima conversora da angiotensina foram administrados até 48 após a internação, uma vez que o estado clínico havia melhorado e a fração de ejeção ventricular esquerda encontrava-se acima de 0,35 por cento. Resultados: Na admissão, a dosagem da norepinefrina foi 1.727,50± 794,96 pg/ml, a de troponina I 24,53 ± 14,09 ng/ml e a fração de ejeção do ventrículo esquerdo foi 0,20 ± 0,056. Após 12 horas, os níveis séricos de norepinefrina e de troponina I diminuíram para a metade dos valores iniciais e a fração de ejeção aumentou para 0,32 ± 0,059. Durante as 24 e 48 horas subseqüentes, a fração de ejeção elevou-se para 0,46 ± 0,045 (p<0,01) e a norepinefrina e de troponina I diminuíram para 526,75 ± 273,73 (p< 0,02) e 2,20 ± 2,36 (p<0,02) respectivamente. Conclusão: É bem provável que a amiodarona, ao agir como neuromodulador, seja responsável pela redução rápida e progressiva dos níveis séricos de norepinefrina.

Background: Children with scorpion envenomation have massive sympathetic activation and variable degrees of left ventricular systolic dysfunction. Objective: To evaluate a rescue protocol for children with severe left ventricular dysfunction secondary to scorpion envenomation. Methods: Four children, after scorpion envenomation, were subjected to a rescue protocol for acute left ventricular dysfunction: Endotracheal intubation and respiratory assistance, electrocardiograms, chest x-Ray, echocardiograms and blood samples for norepinephrine and troponin I serum levels. Samples and echocardiograms were repeated at 12, 24 and 48 hours. Intravenous medications: Dobutamine: 4-6 μg/kg/min. Amiodarone: 3 mg/kg during a 2 hour period. Maintenance: 5 mg/kg/day. Furosemide: 0.5 mg/kg/dose. Diuretics were given when the systemic blood pressure was above percentile fifty. Amiodarone, Dobutamine and Furosemide were administered during the first 48 hours. Beta-adrenergic blockers and angiotensin converting enzyme were given, at 48 hours after admission, once the left ventricular Ejection fraction > 0.35 and the clinical status had improved. Results: On admission, norepinephrine was 1,727.50 ±794.96 pg/ml, troponin I 24.53 ± 14.09 ng/ml and left ventricular ejection fraction 0.20 ± 0.056. At twelve hours, norepinephrine and troponin I serum levels were down to half of the initial values and the ejection fraction increased to 0.32 ± 0.059. During the next 24 and 48 hours, the ejection fraction rose to 0.46 ± 0.045, (p<0.01) and norepinephrine and troponin diminished to 526.75 ± 273.73 (p < 0.02) and 2.20 ± 2.36 (p<0.02) respectively. Conclusion: Amiodarone, by acting as a neuromodulator, is very likely responsible for the early and progressive decrease of serum norepinephrine.

Fundamento: Los niños con picaduras de escorpión sufren activación masiva del sistema nervioso simpático con varios grados de disfunción sistólica ventricular izquierda. Objetivo: Probar un protocolo de rescate en niños con disfunción ventricular severa izquierda ocasionada por picadura de escorpión. Métodos: Cuatro niños tras un escorpión picarlas se sometieron a: incubación endotraqueal y soporte respiratorio, electrocardiograma, radiografía de tórax, ecocardiograma y determinación sérica de la norepinefrina y troponina I. Los análisis se repitieron tras 12, 24 y 48 horas. Las siguientes medicaciones intravenosas se administraron: dobutamina 4-6 mcg/kg/min; amiodarona 3 mg/kg durante dos horas, con dosis de mantenimiento de 5 mg/kg/día; y furosemida 0.5 mg/kg. Amiodarona, dobutamina y furosemida se administraron durante las primeras 48 horas. Bloqueante betaadrenergicos e inhibidores de la enzima convertidora de la angiotensina se administraron hasta 48 tras la internación, una vez que el estado clínico había mejorado y la fracción de eyección ventricular izquierda se hallaba superior a un 0,35 por ciento. Resultados: Al ingreso, la dosificación de la norepinefrina fue 1727,50± 794,96 pg/ml, la de troponina I 24,53 ± 14,09 ng/ml y la fracción de eyección del ventrículo izquierdo fue 0,20 ± 0,056. Tras 12 horas, los niveles séricos de norepinefrina y de troponina I disminuyeron para la mitad de los valores iniciales y la fracción de eyección aumentó para 0,32 ± 0,059. Durante las 24 y 48 horas subsiguientes, la fracción de eyección se elevó para 0,46 ± 0,045 (p<0,01) y la norepinefrina y de troponina I se redujeron para 526,75 ± 273,73 (p< 0,02) y 2,20 ± 2,36 (p<0,02) respectivamente. Conclusión: Es bien probable que la amiodarona, al actuar como neuromodulador, sea responsable de la reducción rápida y progresiva de los niveles séricos de norepinefrina.

Ractopamina em dietas para suínos machos imunocastrados, castrados e fêmeas

The objective of this study was to evaluate the performance and the quantitative characteristics of carcass of immunocastrated, barrows and females in the finishing phase fed with diets containing 10ppm of ractopamine. One hundred and twenty animals were used, with initial weight of 99.1±5.3kg, distributed in a randomized blocks factorial design in 2 x 3 (two ractopamine levels, 0 and 10ppm and three sex), five replicates of four animals each. The inclusion of 10ppm of ractopamine in the diet improved (P 0.05) feed conversion in pigs, independent of sex. The inclusion of ractopamine damaged (P 0.05) the weight gain of the immunocastrated and increased (P 0.05) the weight gain of the barrows and the females, without, however, affect (P>0.05) quantitative carcass characteristics of pigs. The sex was determining factor in performance and carcass quantitative traits and the females had higher (P 0.05) hot carcass yield for immunocastrated male and they have yield above (P 0.05) the barrows. Immunocastrated males and females had higher (P 0.05) percentage of lean meat for barrows. The results of this study highlight the need for studies to adjust the nutrient levels of diets containing ractopamine to immunocastrated pigs.

O objetivo do trabalho foi avaliar o desempenho e as características quantitativas de carcaça de suínos machos imunocastrados, castrados e fêmeas, na fase de terminação, alimentados com dietas contendo 10ppm de ractopamina. Foram utilizados 120 animais, com peso inicial de 99,1±5,3kg, distribuídos em delineamento de blocos ao acaso, em esquema fatorial 2 x 3 (dois níveis de ractopamina, 0 e 10ppm e três sexos), cinco repetições com quatro animais cada. A inclusão de 10ppm de ractopamina na dieta melhorou (P 0,05) a conversão alimentar dos suínos, independentemente do sexo. A inclusão de ractopamina prejudicou (P 0,05) o ganho de peso dos machos imunocastrados e aumentou (P 0,05) o ganho de peso dos machos castrados e das fêmeas, sem, no entanto, afetar (P>0,05) as características quantitativas de carcaça dos suínos. O sexo foi determinante para o desempenho e as características quantitativas de carcaça; as fêmeas apresentaram rendimento de carcaça quente superior (P 0,05) aos machos imunocastrados, que apresentaram rendimento superior (P 0,05) aos machos castrados. Os machos imunocastrados e as fêmeas apresentaram maior (P 0,05) percentual de carne magra em relação aos machos castrados. Os resultados desta pesquisa evidenciam a necessidade de estudos visando à adequação dos níveis nutricionais das dietas contendo ractopamina para suínos imunocastrados.

Ractopamina em dietas para suínos machos imunocastrados, castrados e fêmeas

The objective of this study was to evaluate the performance and the quantitative characteristics of carcass of immunocastrated, barrows and females in the finishing phase fed with diets containing 10ppm of ractopamine. One hundred and twenty animals were used, with initial weight of 99.1±5.3kg, distributed in a randomized blocks factorial design in 2 x 3 (two ractopamine levels, 0 and 10ppm and three sex), five replicates of four animals each. The inclusion of 10ppm of ractopamine in the diet improved (P 0.05) feed conversion in pigs, independent of sex. The inclusion of ractopamine damaged (P 0.05) the weight gain of the immunocastrated and increased (P 0.05) the weight gain of the barrows and the females, without, however, affect (P>0.05) quantitative carcass characteristics of pigs. The sex was determining factor in performance and carcass quantitative traits and the females had higher (P 0.05) hot carcass yield for immunocastrated male and they have yield above (P 0.05) the barrows. Immunocastrated males and females had higher (P 0.05) percentage of lean meat for barrows. The results of this study highlight the need for studies to adjust the nutrient levels of diets containing ractopamine to immunocastrated pigs.

O objetivo do trabalho foi avaliar o desempenho e as características quantitativas de carcaça de suínos machos imunocastrados, castrados e fêmeas, na fase de terminação, alimentados com dietas contendo 10ppm de ractopamina. Foram utilizados 120 animais, com peso inicial de 99,1±5,3kg, distribuídos em delineamento de blocos ao acaso, em esquema fatorial 2 x 3 (dois níveis de ractopamina, 0 e 10ppm e três sexos), cinco repetições com quatro animais cada. A inclusão de 10ppm de ractopamina na dieta melhorou (P 0,05) a conversão alimentar dos suínos, independentemente do sexo. A inclusão de ractopamina prejudicou (P 0,05) o ganho de peso dos machos imunocastrados e aumentou (P 0,05) o ganho de peso dos machos castrados e das fêmeas, sem, no entanto, afetar (P>0,05) as características quantitativas de carcaça dos suínos. O sexo foi determinante para o desempenho e as características quantitativas de carcaça; as fêmeas apresentaram rendimento de carcaça quente superior (P 0,05) aos machos imunocastrados, que apresentaram rendimento superior (P 0,05) aos machos castrados. Os machos imunocastrados e as fêmeas apresentaram maior (P 0,05) percentual de carne magra em relação aos machos castrados. Os resultados desta pesquisa evidenciam a necessidade de estudos visando à adequação dos níveis nutricionais das dietas contendo ractopamina para suínos imunocastrados.