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1.
JAMA ; 323(3): 225-236, 2020 01 21.
Artículo en Inglés | MEDLINE | ID: mdl-31961418

RESUMEN

Importance: It is not known if use of colloid solutions containing hydroxyethyl starch (HES) to correct for intravascular deficits in high-risk surgical patients is either effective or safe. Objective: To evaluate the effect of HES 130/0.4 compared with 0.9% saline for intravascular volume expansion on mortality and postoperative complications after major abdominal surgery. Design, Setting, and Participants: Multicenter, double-blind, parallel-group, randomized clinical trial of 775 adult patients at increased risk of postoperative kidney injury undergoing major abdominal surgery at 20 university hospitals in France from February 2016 to July 2018; final follow-up was in October 2018. Interventions: Patients were randomized to receive fluid containing either 6% HES 130/0.4 diluted in 0.9% saline (n = 389) or 0.9% saline alone (n = 386) in 250-mL boluses using an individualized hemodynamic algorithm during surgery and for up to 24 hours on the first postoperative day, defined as ending at 7:59 am the following day. Main Outcomes and Measures: The primary outcome was a composite of death or major postoperative complications at 14 days after surgery. Secondary outcomes included predefined postoperative complications within 14 days after surgery, durations of intensive care unit and hospital stays, and all-cause mortality at postoperative days 28 and 90. Results: Among 826 patients enrolled (mean age, 68 [SD, 7] years; 91 women [12%]), 775 (94%) completed the trial. The primary outcome occurred in 139 of 389 patients (36%) in the HES group and 125 of 386 patients (32%) in the saline group (difference, 3.3% [95% CI, -3.3% to 10.0%]; relative risk, 1.10 [95% CI, 0.91-1.34]; P = .33). Among 12 prespecified secondary outcomes reported, 11 showed no significant difference, but a statistically significant difference was found in median volume of study fluid administered on day 1: 1250 mL (interquartile range, 750-2000 mL) in the HES group and 1500 mL (interquartile range, 750-2150 mL) in the saline group (median difference, 250 mL [95% CI, 83-417 mL]; P = .006). At 28 days after surgery, 4.1% and 2.3% of patients had died in the HES and saline groups, respectively (difference, 1.8% [95% CI, -0.7% to 4.3%]; relative risk, 1.76 [95% CI, 0.79-3.94]; P = .17). Conclusions and Relevance: Among patients at risk of postoperative kidney injury undergoing major abdominal surgery, use of HES for volume replacement therapy compared with 0.9% saline resulted in no significant difference in a composite outcome of death or major postoperative complications within 14 days after surgery. These findings do not support the use of HES for volume replacement therapy in such patients. Trial Registration: ClinicalTrials.gov Identifier: NCT02502773.


Asunto(s)
Abdomen/cirugía , Fluidoterapia/métodos , Derivados de Hidroxietil Almidón/uso terapéutico , Complicaciones Posoperatorias/prevención & control , Solución Salina/uso terapéutico , Procedimientos Quirúrgicos Operativos/efectos adversos , Lesión Renal Aguda/prevención & control , Anciano , Método Doble Ciego , Femenino , Humanos , Cuidados Intraoperatorios , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/mortalidad , Estadísticas no Paramétricas
2.
Braz Oral Res ; 33: e021, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31508722

RESUMEN

This study investigated the effectiveness of XP-Endo Finisher (XPF) associated with XP-Endo Shaper (XPS) or Reciproc Blue (RB) files in reducing bacterial load in oval-shaped root canals (RC) during chemomechanical preparation (CMP) using 0.9% saline solution (NaCl) or 2.5% sodium hypochlorite (NaOCl). Eighty mandibular incisors with single oval-shaped RC were contaminated with Enterococcus faecalis. The teeth were randomly assigned to eight experimental groups (n = 10) according to the CMP, as follows: G1: XPS, G2: XPS + XPF, G3: RB, and G4: RB + XPF. CMP was performed with NaCl or NaOCl. The reduction of bacterial load was assessed by colony-forming unit count before (S1) and after (S2) CMP. Data normality was verified by using Shapiro-Wilk test. ANOVA, Tukey's test, and Bonferroni post-hoc test were used at a 5% significance level. Culturable bacteria were present in all S1 samples (p>0.05). All instrumentation techniques were effective in reducing bacterial load, irrespective of the irrigating solution (p < 0.05). With the use of NaCl, RB was more effective than XPS (p = 0.035). With the use of NaOCl, XPS and RB presented similar effectiveness (p = 0.779). XPF enhanced the bacterial reduction of both systems tested (p < 0.05). The use of NaOCl improved the CMP, irrespective of the instrumentation technique used (p < 0.05). In conclusion, XPS and RB files are effective in reducing bacterial levels in oval-shaped RC. The use of XPF as a method of agitation of the irrigating solution improved the cleaning efficiency of both file systems tested. Mechanical preparation performed with saline solution decreased culturable bacteria from the root canal, but antimicrobial substances such as NaOCl should be used to achieve a significantly better disinfection.


Asunto(s)
Carga Bacteriana , Instrumentos Dentales , Cavidad Pulpar/anatomía & histología , Preparación del Conducto Radicular/instrumentación , Cavidad Pulpar/microbiología , Desinfectantes/uso terapéutico , Enterococcus faecalis/aislamiento & purificación , Infecciones por Bacterias Grampositivas , Humanos , Incisivo , Ensayo de Materiales , Solución Salina/uso terapéutico , Hipoclorito de Sodio/uso terapéutico
3.
Mol Med Rep ; 20(4): 3942-3950, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31485662

RESUMEN

Intracarotid cold saline infusion (ICSI) brings about neuroprotective effects in ischemic stroke. However, the involvement of serum and glucocorticoid­regulated kinase 1 (SGK1) in the underlying mechanism of ICSI is not fully understood; therefore, we used the rat middle cerebral artery occlusion (MCAO) model to investigate the neuroprotective effects of ICSI on ischemic stroke in rats, as well as the involvement of SGK1 in these effects. ICSI decreased infarct size and brain swelling, as determined by 2,3,5­triphenyltetrazolium chloride staining and the dry­wet weight method, respectively. The results of terminal deoxynucleotidyl transferase mediated nick end labeling (TUNEL) and Nissl staining showed that ICSI also suppressed apoptosis and increased the relative integral optical density (IOD) values of Nissl bodies in the rat MCAO model. Regarding the mechanism, the results of immunohistochemistry and western blotting revealed that ICSI upregulated SGK1 expression and downregulated beclin­1 and LC­3 expression in the rat MCAO model. In addition, SGK1 knockdown increased ICSI­mediated infarct size and brain swelling, promoted apoptosis, and reduced the IOD values of Nissl bodies in the rat MCAO model. In addition, we found that SGK1 knockdown upregulated beclin­1 and LC­3 expression mediated by ICSI. Overall, ICSI had a neuroprotective effect on ischemic stroke after reperfusion by upregulating SGK1 and inhibiting autophagy.


Asunto(s)
Proteínas Inmediatas-Precoces/genética , Infarto de la Arteria Cerebral Media/tratamiento farmacológico , Fármacos Neuroprotectores/uso terapéutico , Proteínas Serina-Treonina Quinasas/genética , Solución Salina/uso terapéutico , Regulación hacia Arriba/efectos de los fármacos , Animales , Apoptosis/efectos de los fármacos , Encéfalo/efectos de los fármacos , Encéfalo/metabolismo , Encéfalo/patología , Edema Encefálico/tratamiento farmacológico , Edema Encefálico/genética , Edema Encefálico/patología , Frío , Proteínas Inmediatas-Precoces/análisis , Infarto de la Arteria Cerebral Media/genética , Infarto de la Arteria Cerebral Media/patología , Infusiones Intraarteriales , Masculino , Neuroprotección/efectos de los fármacos , Fármacos Neuroprotectores/administración & dosificación , Proteínas Serina-Treonina Quinasas/análisis , Interferencia de ARN , Ratas , Ratas Sprague-Dawley , Solución Salina/administración & dosificación
4.
Cochrane Database Syst Rev ; 7: CD012247, 2019 07 19.
Artículo en Inglés | MEDLINE | ID: mdl-31334842

RESUMEN

BACKGROUND: Fluid therapy is one of the main interventions provided for critically ill patients, although there is no general consensus regarding the type of solution. Among crystalloid solutions, 0.9% saline is the most commonly administered. Buffered solutions may offer some theoretical advantages (less metabolic acidosis, less electrolyte disturbance), but the clinical relevance of these remains unknown. OBJECTIVES: To assess the effects of buffered solutions versus 0.9% saline for resuscitation in critically ill adults and children. SEARCH METHODS: We searched the following databases to July 2018: CENTRAL, MEDLINE, Embase, CINAHL, and four trials registers. We checked references, conducted backward and forward citation searching of relevant articles, and contacted study authors to identify additional studies. We imposed no language restrictions. SELECTION CRITERIA: We included randomized controlled trials (RCTs) with parallel or cross-over design examining buffered solutions versus intravenous 0.9% saline in a critical care setting (resuscitation or maintenance). We included studies on participants with critical illness (including trauma and burns) or undergoing emergency surgery during critical illness who required intravenous fluid therapy. We included studies of adults and children. We included studies with more than two arms if they fulfilled all of our inclusion criteria. We excluded studies performed in persons undergoing elective surgery and studies with multiple interventions in the same arm. DATA COLLECTION AND ANALYSIS: We used Cochrane's standard methodological procedures. We assessed our intervention effects using random-effects models, but when one or two trials contributed to 75% of randomized participants, we used fixed-effect models. We reported outcomes with 95% confidence intervals (CIs). MAIN RESULTS: We included 21 RCTs (20,213 participants) and identified three ongoing studies. Three RCTs contributed 19,054 participants (94.2%). Four RCTs (402 participants) were conducted among children with severe dehydration and dengue shock syndrome. Fourteen trials reported results on mortality, and nine reported on acute renal injury. Sixteen included trials were conducted in adults, four in the paediatric population, and one trial limited neither minimum or maximum age as an inclusion criterion. Eight studies involving 19,218 participants were rated as high methodological quality (trials with overall low risk of bias according to the domains: allocation concealment, blinding of participants/assessors, incomplete outcome data, and selective reporting), and in the remaining trials, some form of bias was introduced or could not be ruled out.We found no evidence of an effect of buffered solutions on in-hospital mortality (odds ratio (OR) 0.91, 95% CI 0.83 to 1.01; 19,664 participants; 14 studies; high-certainty evidence). Based on a mortality rate of 119 per 1000, buffered solutions could reduce mortality by 21 per 1000 or could increase mortality by 1 per 1000. Similarly, we found no evidence of an effect of buffered solutions on acute renal injury (OR 0.92, 95% CI 0.84 to 1.00; 18,701 participants; 9 studies; low-certainty evidence). Based on a rate of 121 per 1000, buffered solutions could reduce the rate of acute renal injury by 19 per 1000, or result in no difference in the rate of acute renal injury. Buffered solutions did not show an effect on organ system dysfunction (OR 0.80, 95% CI 0.40 to 1.61; 266 participants; 5 studies; very low-certainty evidence). Evidence on the effects of buffered solutions on electrolyte disturbances varied: potassium (mean difference (MD) 0.09, 95% CI -0.10 to 0.27; 158 participants; 4 studies; very low-certainty evidence); chloride (MD -3.02, 95% CI -5.24 to -0.80; 351 participants; 7 studies; very low-certainty evidence); pH (MD 0.04, 95% CI 0.02 to 0.06; 200 participants; 3 studies; very low-certainty evidence); and bicarbonate (MD 2.26, 95% CI 1.25 to 3.27; 344 participants; 6 studies; very low-certainty evidence). AUTHORS' CONCLUSIONS: We found no effect of buffered solutions on preventing in-hospital mortality compared to 0.9% saline solutions in critically ill patients. The certainty of evidence for this finding was high, indicating that further research would detect little or no difference in mortality. The effects of buffered solutions and 0.9% saline solutions on preventing acute kidney injury were similar in this setting. The certainty of evidence for this finding was low, and further research could change this conclusion. Patients treated with buffered solutions showed lower chloride levels, higher levels of bicarbonate, and higher pH. The certainty of evidence for these findings was very low. Future research should further examine patient-centred outcomes such as quality of life. The three ongoing studies once published and assessed may alter the conclusions of the review.


Asunto(s)
Enfermedad Crítica , Fluidoterapia/métodos , Solución Salina/uso terapéutico , Adulto , Niño , Cuidados Críticos , Mortalidad Hospitalaria , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Soluciones para Rehidratación
6.
Oxid Med Cell Longev ; 2019: 7850324, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31182999

RESUMEN

Ulcerative colitis (UC) is an inflammation-related disease involved in uncontrolled inflammation and oxidative stress and is characterized by high recurrence and relapse risk. As a rising star in gas medicine, methane owns the properties of anti-inflammation, antioxidation, and antiapoptosis. Based on the possible mechanism, we aimed to investigate the effect of methane on UC. Methane-rich saline (MRS) was introduced here, and UC was induced by acetic acid. All the C57BL/6 mice were allocated into groups as follows: control group, colitis model group, colitis treated with salazosulfapyridine (SASP) group, and colitis treated with MRS (1 or 10 ml/kg) groups. Tissue damage, the degree of inflammation, oxidative stress, and apoptosis were evaluated in the study, as well as the TLR4/NF-κB/MAPK and IL-10/JAK1/STAT3 signaling pathways for further exploration of the potential mechanism. The results showed that MRS (1) alleviated tissue damage caused by acetic acid, (2) controlled acetic acid-induced inflammation, (3) inhibited acetic acid-caused oxidative stress, (4) reduced colonic cell apoptosis due to acetic acid, (5) suppressed the TLR-4/NF-κB/MAPK signaling pathway, and (6) activated IL-10/JAK1/STAT3 anti-inflammatory response to improve the injury induced by acetic acid. We conclude that MRS has a protective effect on acetic acid-induced ulcerative colitis in mice via blocking the TLR4/NF-κB/MAPK signaling pathway and promoting the IL-10/JAK1/STAT3-mediated anti-inflammatory response.


Asunto(s)
Ácido Acético/farmacología , Colitis Ulcerosa/inducido químicamente , Interleucina-10/metabolismo , Janus Quinasa 1/metabolismo , Metano/química , FN-kappa B/metabolismo , Factor de Transcripción STAT3/metabolismo , Solución Salina/química , Solución Salina/uso terapéutico , Receptor Toll-Like 4/metabolismo , Animales , Apoptosis/efectos de los fármacos , Masculino , Ratones , Ratones Endogámicos C57BL , Transducción de Señal/efectos de los fármacos
8.
J Appl Oral Sci ; 27: e20180030, 2019 May 20.
Artículo en Inglés | MEDLINE | ID: mdl-31116277

RESUMEN

OBJECTIVES: To evaluate the effect of calcium hydroxide (CH) associated with two different vehicles as a capping material for pulp tissue in primary molars, compared with mineral trioxide aggregate (MTA). METHODOLOGY: Forty-five primary mandibular molars with dental caries were treated by conventional pulpotomy using one of the following materials: MTA only (MTA group), CH with saline (CH+saline group) and CH with polyethylene glycol (CH+PEG group) (15 teeth/group). Clinical and periapical radiographic examinations of the pulpotomized teeth were performed 3, 6, and 12 months after treatment. Data were tested by chi-squared analysis and a multiple comparison post-test. RESULTS: The MTA group showed both clinical and radiographic treatment success in 14/14 teeth (100%), at all follow-up appointments. By clinical evaluation, no teeth in the CH+saline and CH+PEG groups had signs of mobility, fistula, swelling or inflammation of the surrounding gingival tissue. However, in the CH+saline group, radiographic analysis detected internal resorption in up to 9/15 teeth (67%), and inter-radicular bone resorption and furcation radiolucency in up to 5/15 teeth (36%), from 3 to 12 months of follow-up. In the CH+PEG group, 2/11 teeth (18%) had internal resorption and 1/11 teeth (9%) presented bone resorption and furcation radiolucency at all follow-up appointments. CONCLUSION: CH with PEG performed better than CH with saline as capping material for pulpotomy of primary teeth. However, both combinations yielded clinical and radiographic results inferior to those of MTA alone.


Asunto(s)
Compuestos de Aluminio/uso terapéutico , Compuestos de Calcio/uso terapéutico , Hidróxido de Calcio/uso terapéutico , Óxidos/uso terapéutico , Materiales de Recubrimiento Pulpar y Pulpectomía/uso terapéutico , Pulpotomía/métodos , Silicatos/uso terapéutico , Diente Primario/cirugía , Hidróxido de Calcio/química , Niño , Preescolar , Combinación de Medicamentos , Estudios de Seguimiento , Humanos , Estudios Prospectivos , Materiales de Recubrimiento Pulpar y Pulpectomía/química , Radiografía Dental , Solución Salina/química , Solución Salina/uso terapéutico , Factores de Tiempo , Diente Primario/diagnóstico por imagen , Resultado del Tratamiento
9.
Scand J Med Sci Sports ; 29(8): 1223-1231, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31044450

RESUMEN

BACKGROUND: High volume injection (HVI) shows promising results in the treatment of chronic midportion Achilles tendinopathy (AT). HVI consists of a large volume of saline with a small amount of corticosteroid and local anesthetic. OBJECTIVE: To determine the effect of corticosteroid in HVI in AT. METHODS: A total of 28 men (18-59 years) with chronic (>3 months) AT were included in a double-blinded RCT and followed for 24 weeks. All performed eccentric training and randomized to either (a) HVI injection with corticosteroid or (b) HVI injection without corticosteroid. Outcomes included self-reported function (VISA-A score) and pain (VAS score) and ultrasound imaging (tendon thickness, Doppler flow). RESULTS: VISA-A and VAS score improved in both groups at all time-points (P < 0.05). VISA-A improvement was significantly greater in HVI with corticosteroid (mean ± SEM; 6-weeks = 31 ± 3 points; 12-weeks = 32 ± 5 points) vs HVI without corticosteroid (6 weeks = 14 ± 3; 12-weeks = 17 ± 3) at 6 and 12 weeks (P < 0.05), but not at 24 weeks. Decrease in VAS scores was significantly greater in HVI with corticosteroid (6 weeks = 55 ± 3 mm; 12 weeks = 53 ± 5 mm) vs HVI without corticosteroid (6 weeks = 16 ± 3 mm; 12 weeks = 25 ± 5 mm) at 6 and 12 weeks (P < 0.05) but not at 24 weeks. Tendon thickness decreased significantly in both groups at all time-points (P < 0.05), but more in the HVI with corticosteroid vs HVI without corticosteroid at 6 and 12 weeks (P < 0.05) but not at 24 weeks. CONCLUSION: High volume injection with or without corticosteroid in combination with eccentric training seems effective in AT. HVI with corticosteroid showed a better short-term improvement than HVI without corticosteroid indicating a short-term effect of corticosteroid in HVI treatment of AT.


Asunto(s)
Tendón Calcáneo/fisiopatología , Corticoesteroides/uso terapéutico , Solución Salina/uso terapéutico , Tendinopatía/terapia , Adulto , Método Doble Ciego , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Solución Salina/administración & dosificación
10.
Int Forum Allergy Rhinol ; 9(S1): S9-S15, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-31087637

RESUMEN

BACKGROUND: Chronic rhinosinusitis (CRS) has previously been thought to occur secondary to infectious or obstructive etiologies. However, in recent years, primary CRS has been more discretely defined as diffuse airway inflammation, similar to asthma. Adequate medical and surgical therapy are needed to control the inflammation. Our purpose in this study was to evaluate the efficacy and safety of topical corticosteroid treatment. METHODS: A focused literature review was conducted and we identified 11 original articles from the years 2013-2018 evaluating safety or efficacy of topical corticosteroid irrigations. RESULTS: Eleven articles were identified. One study found significant benefit between corticosteroid irrigations versus corticosteroid sprays. Two studies found significant benefit between corticosteroid irrigations compared to saline irrigations while two did not. One study found significant improvement in certain patient populations when using corticosteroid irrigations compared to no irrigation. Five studies found no significant increase in risk of adverse side effects with the use of topical corticosteroids. CONCLUSION: Many factors are associated with efficacious and adequate treatment of primary CRS. The pathology must be correctly diagnosed and be inflammatory in nature. The treatment paradigm should include wide and complete endoscopic sinus surgery for the adequate delivery of topical therapy. Topical therapy should be delivered in large-volume, low-pressure devices with adequate dosing. Although there is some systemic absorption, multiple studies have demonstrated that long-term, daily use of topical corticosteroids does not increase intraocular pressure, suppress the hypothalamic-pituitary-adrenal axis, or increase the risk of subcapsular cataracts. Therefore, topical corticosteroid irrigations should be considered a part of first-line medical treatment in postsurgical CRS patients.


Asunto(s)
Corticoesteroides/uso terapéutico , Lavado Nasal (Proceso) , Rinitis/tratamiento farmacológico , Sinusitis/tratamiento farmacológico , Corticoesteroides/administración & dosificación , Corticoesteroides/efectos adversos , Enfermedad Crónica , Humanos , Lavado Nasal (Proceso)/efectos adversos , Rociadores Nasales , Cirugía Endoscópica por Orificios Naturales , Rinitis/cirugía , Solución Salina/administración & dosificación , Solución Salina/efectos adversos , Solución Salina/uso terapéutico , Sinusitis/cirugía , Resultado del Tratamiento
11.
J Vet Intern Med ; 33(4): 1593-1601, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31134702

RESUMEN

BACKGROUND: Intravenous continuous rate infusion (IVCRI) of lispro at a starting dose of 0.09 U/kg/h and the use of 0.9% sodium chloride (NaCl) for fluid resuscitation in cats with diabetic ketoacidosis (DKA) have not been reported. Protocols for correction of electrolyte deficiencies in cats with DKA are lacking. OBJECTIVES: To characterize the use of IVCRI lispro at an initial dose of 0.09 U/kg/h and the use of NaCl for resuscitation. Explore protocols for electrolyte supplementation in cats with DKA. ANIMALS: Twelve cats with DKA enrolled from the cat population of a university hospital. METHODS: Randomized, controlled, blinded study. Six cats were randomized into each group, the lispro insulin treatment group (LITG) and regular insulin treatment group (RITG). All cats received IVCRI fluid resuscitation with NaCl. Solutions with higher than previously published electrolyte concentrations were used to treat electrolyte deficiencies. RESULTS: The median time to blood glucose (BG) concentration <250 mg/dL was significantly shorter in the LITG (median 7 hours, 2-10 hours) than the RITG (median 12.5 hours, 8-20 hours; P = .02). Two cats had nonclinical hypoglycemia (BG = 40 mg/dL). The most rapid change in 157 measurements of corrected sodium concentrations was 0.7 mmol/L/h. Low concentrations of serum sodium, potassium, phosphate, and magnesium were over 3 times more common than above normal electrolyte concentrations, despite supplementation with fluids of high electrolyte concentrations. CONCLUSIONS AND CLINICAL IMPORTANCE: Lispro at a starting dose of 0.09 U/kg/h and NaCl administered for fluid resuscitation are safe and effective for treatment of DKA in cats.


Asunto(s)
Enfermedades de los Gatos/tratamiento farmacológico , Cetoacidosis Diabética/veterinaria , Insulina Lispro/uso terapéutico , Animales , Glucemia/efectos de los fármacos , Gatos , Cetoacidosis Diabética/tratamiento farmacológico , Electrólitos/administración & dosificación , Electrólitos/sangre , Femenino , Infusiones Intravenosas/veterinaria , Insulina/administración & dosificación , Masculino , Distribución Aleatoria , Solución Salina/uso terapéutico
12.
Clin Nephrol ; 91(6): 344-352, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30935460

RESUMEN

AIMS: We attempted to classify 115 consecutive nonedematous hyponatremic patients according to their history and saline responsiveness. We hereby describe 6 out of them presenting a transient renal salt wasting (TRSW) state of unknown origin. MATERIALS AND METHODS: Six patients with an initial SNa of 126 ± 3 mEq/L were included in the study. They were treated with 2 L isotonic saline infusion over 24 hours. The evolution of the biochemical data of 5 patients were compared to 6 patients with syndrome of inappropriate antidiuretic hormone (ADH) secretion (SIADH), 6 hyponatremias following the use of thiazides, and to 5 salt-depleted hyponatremic patients of similar age and body weight, treated in the same way. RESULTS: The mean values of FEurea and FEuric acid in the 6 described patients, together with a clearly inappropriate natriuresis suggested SIADH. However, the high mean fractional potassium excretion (FEK = 34 ± 15%) was not observed in SIADH (13 ± 3%) (p < 0.01). Plasma sodium levels improved quickly after saline infusion in most of these patients, while fractional solute excretions and diuresis decreased. Calciuria is increased in patients with renal salt waisting (RSW), while low calciuria values are observed in the thiazide group. Four of the 6 hyponatremic patients were admitted for syncopal malaise or fall. CONCLUSION: We observed in 6 out of 115 consecutive hyponatremic patients a TRSW. RSW as a diagnosis has to be considered when in hyponatremia with excessive natriuresis, high FEK and an intake of diuretics is ruled out. This hyponatremia is saline-responsive, but relapse can be frequently observed.


Asunto(s)
Hiponatremia/sangre , Hiponatremia/etiología , Enfermedades Renales/sangre , Sodio/sangre , Anciano , Anciano de 80 o más Años , Calcio/orina , Diuresis , Diuréticos/efectos adversos , Femenino , Fluidoterapia , Humanos , Hiponatremia/terapia , Hiponatremia/orina , Síndrome de Secreción Inadecuada de ADH/sangre , Síndrome de Secreción Inadecuada de ADH/complicaciones , Síndrome de Secreción Inadecuada de ADH/orina , Soluciones Isotónicas , Enfermedades Renales/complicaciones , Enfermedades Renales/orina , Potasio/orina , Solución Salina/uso terapéutico , Tiazidas/efectos adversos , Urea/orina , Ácido Úrico/orina
13.
Environ Toxicol Pharmacol ; 67: 117-123, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30818178

RESUMEN

This study was designed to investigate the neuroprotective effect of hyperoxygenate hydrogen-rich saline (HOHS) against brain injury induced by carbon monoxide (CO) poisoning in rats. A rat model of CO poisoning was established by administering CO via intraperitoneal injection to male Sprague-Dawley rats. Forty-eight adult male rats were randomly divided into the following groups: normal control group (NG), CO poisoning group (CO), HOS treatment group (hyperoxygenated solution, HOS) and HOHS treatment group (HOHS). After CO poisoning, the carboxyhemoglobin (COHb) contents in the blood of rats in all the CO poisoning groups were increased significantly. However, HOS and HOHS significantly decreased COHb contents, furthermore, the HOHS group had lower COHb contents than the HOS group. Arterial oxygen partial pressure (PaO2) and arterial oxygen saturation (SaO2) results showed that HOS and HOHS could improve the oxygenation of the rats with CO poisoning. Compared with the CO group, the HOS group and the HOHS group had persistently neuroprotective effect on CO-induced brain injury, as assessed by modified neurological severity score (mNSS), furthermore, the HOHS group had better neurological functional recovery than the HOS group. The neuronal apoptosis induced by CO was also evaluated. Except the NG group, all the CO-poisoning groups had varying degrees of neuronal apoptosis. There was lesser degree of neuronal apoptosis in both the HOS group and the HOHS group than that in the CO group. Moreover, the HOHS group had more minor degree of neuronal apoptosis than the HOS group. Compared with the CO group, the free radicals production in the HOS group and the HOHS group were significantly inhibited. In addition, there were significantly difference in the free radicals production between the HOS group and the HOHS group. We could conclude that HOHS exerted a stronger neuroprotective effect against CO-induced brain injury than HOS, and the neuroprotective mechanism of HOHS may be related with inhibition of both neuronal apoptosis and free radicals.


Asunto(s)
Lesiones Encefálicas/tratamiento farmacológico , Intoxicación por Monóxido de Carbono/tratamiento farmacológico , Fármacos Neuroprotectores/uso terapéutico , Solución Salina/uso terapéutico , Soluciones/uso terapéutico , Animales , Apoptosis/efectos de los fármacos , Lesiones Encefálicas/etiología , Lesiones Encefálicas/metabolismo , Intoxicación por Monóxido de Carbono/complicaciones , Intoxicación por Monóxido de Carbono/metabolismo , Carboxihemoglobina/análisis , Corteza Cerebral/efectos de los fármacos , Corteza Cerebral/metabolismo , Hipocampo/efectos de los fármacos , Hipocampo/metabolismo , Masculino , Neuronas/efectos de los fármacos , Ratas Sprague-Dawley
15.
Medicina (Kaunas) ; 55(3)2019 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-30871128

RESUMEN

Background and objectives: Hyperthermia with dehydration alters several brain structure volumes, mainly by changing plasma osmolality, thus strongly affecting neural functions (cognitive and motor). Here, we aimed to examine whether the prevention of significant dehydration caused by passively induced whole-body hyperthermia attenuates peripheral and/or central fatigability during a sustained 2-min isometric maximal voluntary contraction (MVC). Materials and Methods: Ten healthy and physically active adult men (21 ± 1 years of age) performed an isometric MVC of the knee extensors for 2 min (2-min MVC) under control (CON) conditions, after passive lower-body heating that induced severe whole-body hyperthermia (HT, Tre > 39 °C) with dehydration (HT-D) and after HT with rehydration (HT-RH). Results: In the HT-D trial, the subjects lost 0.94 ± 0.15 kg (1.33% ± 0.13%) of their body weight; in the HT-RH trial, their body weight increased by 0.1 ± 0.42 kg (0.1% ± 0.58%). After lower-body heating, the HT-RH trial (vs. HT-D trial) was accompanied by a significantly lower physiological stress index (6.77 ± 0.98 vs. 7.40 ± 1.46, respectively), heart rate (47.8 ± 9.8 vs. 60.8 ± 13.2 b min-1, respectively), and systolic blood pressure (-12.52 ± 5.1 vs. +2.3 ± 6.4, respectively). During 2-min MVC, hyperthermia (HT-D; HT-RH) resulted in greater central fatigability compared with the CON trial. The voluntary activation of exercising muscles was less depressed in the HT-RH trial compared with the HT-D trial. Over the exercise period, electrically (involuntary) induced torque decreased less in the HT-D trial than in the CON and HT-RH trials. Conclusions: Our results suggest that pre-exercise rehydration might have the immediate positive effect of reducing physiological thermal strain, thus attenuating central fatigability even when exercise is performed during severe (Tre > 39 °C) HT, induced by passive warming of the lower body.


Asunto(s)
Deshidratación/prevención & control , Ejercicio/fisiología , Fiebre/tratamiento farmacológico , Fluidoterapia , Contracción Isométrica/fisiología , Solución Salina/uso terapéutico , Estrés Fisiológico , Adulto , Análisis de Varianza , Atletas , Presión Sanguínea/fisiología , Temperatura Corporal/fisiología , Voluntarios Sanos , Frecuencia Cardíaca/fisiología , Humanos , Rodilla/fisiología , Masculino , Músculo Esquelético/fisiología , Estado de Hidratación del Organismo/fisiología , Estadísticas no Paramétricas , Adulto Joven
17.
Thromb Res ; 176: 39-45, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30776686

RESUMEN

INTRODUCTION: Fluid resuscitation is a cornerstone of severe sepsis management, however there are many uncertainties surrounding the type and volume of fluid that is administered. The entire spectrum of coagulopathies can be seen in sepsis, from asymptomatic aberrations to fulminant disseminated intravascular coagulation (DIC). The aim of this study was to determine if fluid resuscitation with saline contributes to the haemostatic derangements in an ovine model of endotoxemic shock. MATERIALS AND METHODS: Twenty-one adult female sheep were randomly divided into no endotoxemia (n = 5) or endotoxemia groups (n = 16) with an escalating dose of lipopolysaccharide (LPS) up to 4 µg/kg/h administered to achieve a mean arterial pressure below 60 mmHg. Endotoxemia sheep received either no bolus fluid resuscitation (n = 8) or a 0.9% saline bolus (40 mL/kg over 60 min) (n = 8). No endotoxemia, saline only animals (n = 5) underwent fluid resuscitation with a 0.9% bolus of saline as detailed above. Hemodynamic support with vasopressors was initiated if needed, to maintain a mean arterial pressure (MAP) of 60-65 mm Hg in all the groups. RESULTS: Rotational thromboelastometry (ROTEM®) and conventional coagulation biomarker tests demonstrated sepsis induced derangements to secondary haemostasis. This effect was exacerbated by saline fluid resuscitation, with low pH (p = 0.036), delayed clot initiation and formation together with deficiencies in naturally occurring anti-coagulants antithrombin (p = 0.027) and Protein C (p = 0.001). CONCLUSIONS: Endotoxemia impairs secondary haemostasis and induces changes in the intrinsic, extrinsic and anti-coagulant pathways. These changes to haemostasis are exacerbated following resuscitation with 0.9% saline, a commonly used crystalloid in clinical settings.


Asunto(s)
Endotoxemia/terapia , Hemostasis , Solución Salina/uso terapéutico , Animales , Presión Sanguínea/efectos de los fármacos , Modelos Animales de Enfermedad , Endotoxemia/sangre , Endotoxemia/fisiopatología , Femenino , Fluidoterapia , Hemostasis/efectos de los fármacos , Resucitación , Ovinos
18.
Intern Med ; 58(13): 1939-1942, 2019 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-30799365

RESUMEN

A 77-year-old woman who had taken a single oral dose of duloxetine subsequently developed a headache and nausea. On the first day, her serum sodium level was 135 mEq/L. She became confused on the third day. Her serum sodium level was 119 mEq/L and her antidiuretic hormone level was 1.9 IU. We diagnosed her with acute hyponatremia from duloxetine-induced syndrome of inappropriate antidiuretic hormone secretion (SIADH). This case suggests that we must not rule out SIADH on the basis of normal serum sodium levels when a patient who has started serotonin-norepinephrine reuptake inhibitor (SNRI) treatment presents with symptoms similar to hyponatremia.


Asunto(s)
Clorhidrato de Duloxetina/efectos adversos , Hiponatremia/inducido químicamente , Hiponatremia/tratamiento farmacológico , Síndrome de Secreción Inadecuada de ADH/inducido químicamente , Síndrome de Secreción Inadecuada de ADH/tratamiento farmacológico , Solución Salina/uso terapéutico , Inhibidores de la Captación de Serotonina/efectos adversos , Administración Intravenosa , Anciano , Femenino , Humanos , Hiponatremia/diagnóstico , Síndrome de Secreción Inadecuada de ADH/diagnóstico , Solución Salina/administración & dosificación , Resultado del Tratamiento
20.
Burns ; 45(2): 335-340, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30686697

RESUMEN

BACKGROUND: Ringer lactate is the main fluid for resuscitation of acute burns. However it is not a complete fluid alone, as it does not take care of sugar and electrolyte balance adequately. This study has been carried out to compare the use of Ringer lactate (RL) alone and combination of RL with Dextrose Normal Saline (DNS) as fluid replacement therapy in acute burn. OBJECTIVE: To assess the biochemical parameters with the use of DNS as maintenance fluid in combination with Ringer lactate as resuscitation fluid in acute burns resuscitation. METHOD: A prospective randomized control study has been carried out by enrolling 200 patients into 2 groups, treated in ICU and resuscitated by using Modification of Brooke's formula (2mL/kg/% TBSA for resuscitation plus 2500mL maintenance). Group A received RL for resuscitation and DNS as maintenance in 1st 72h of burns. Group B received RL only for 1st 72h. The effects of this on various blood parameters were studied. RESULTS: Mean value of sodium at 24h was 137.79±3.89 in group A and was 133.2±4.57 (p<.0001) in group B. The sodium levels remained in range of 137-138 (p<.0001) in group A with only 22% patients showing lower range of sodium levels, whereas, there was a falling trend (p<.0001) of sodium levels in group B on subsequent days with 54.00% (p<.0001) showing hyponatremia on 1st day which increased to 76% on 3rd day. Mean values of early morning random blood sugar (RBS) levels in group A remained between 165.5±65.51mg/dL-115.82±32.52mg/dL on all 3days but in group B there was a falling trend from 127.49±46.11mg/dL to 102.84±22.92mg/dL by 3rd day. Thus, there was significant difference in levels of sodium and RBS in patients receiving DNS as maintenance fluid in addition to RL in acute phase. CONCLUSION: RL is not an ideal fluid for maintenance as it is low in sodium (130mEq/L) as well as potassium (4mEq/L) in view of daily electrolyte requirement. There is no glucose content in it to provide calories. Therefore, DNS should be added as daily maintenance fluid with RL as replacement for evaporative losses following burns.


Asunto(s)
Quemaduras/terapia , Fluidoterapia/métodos , Adolescente , Adulto , Anciano , Glucemia/metabolismo , Unidades de Quemados , Femenino , Glucosa/uso terapéutico , Humanos , Hiperglucemia/prevención & control , Hiponatremia/prevención & control , Masculino , Persona de Mediana Edad , Lactato de Ringer/uso terapéutico , Solución Salina/uso terapéutico , Choque/prevención & control , Sodio/sangre , Centros de Atención Terciaria , Adulto Joven
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