Isolated Nocturnal Hypertension in People Living With Human Immunodeficiency Virus: A Cross-Sectional Study.

BACKGROUND: Nocturnal hypertension (NH) is a potent cardiovascular risk factor described frequently in people with HIV (PWH). Isolated NH (INH) is less well reported in PWH because of the need for ambulatory blood pressure monitoring (ABPM) in office normotensive patients. We aim to document the prevalence of NH and INH and the clinical factors associated with these phenotypes. METHODS: Cross-sectional study from an HIV program in Argentina. Office and ABPM measurements, as well as clinical and laboratory exploration, were performed. We defined INH as NH with daytime normotension in patients with office normotension. RESULTS: We obtained ABPM in 66 PWH, 60% male, aged 44.7 (IQR 27-69) years; 87% receiving antiretroviral therapy, and 86.2% virologically suppressed. ABPM-based hypertension prevalence was 54.7% (95% CI: 42.5-66.3). The prevalence of NH was 48.5% (32/66), while the INH prevalence was 19.7% (95% CI: 11.7-30.9). No differences were found regarding sex, HIV viral load, CD4+ T lymphocytes count, or years of infection between normotensive and INH patients. Multiple linear regression model adjusted for sex and age determined that body mass index (ß = 0.93, P < 0.01), plasma uric acid (ß = 0.25, P = 0.04), plasma potassium (ß = -10.1, P = 0.01), and high-sensitivity C-reactive protein (hs-CRP) (ß = 0.78, P = 0.02) independently predicted nocturnal systolic blood pressure (BP) in PWH. In a multiple logistic regression model adjusted for age and sex, the presence of sedentariness, plasma potassium <4 mEq/L, BMI, and hs-CRP levels were predictors of INH. CONCLUSION: INH is highly prevalent in PWH. Metabolic and inflammatory markers predict nocturnal SBP in PWH.

Social determinants of blood pressure control in a middle-income country in Latin America.

Blood pressure (BP) control is a key intervention to decrease cardiovascular diseases (CVD), the main cause of death in low and middle-income countries (MIC). Scarce data on the determinants of BP control in Latin America are available. Our objective is to explore the role of gender, age, education, and income as social determinants of BP control in Argentina, a MIC with a universal health care system. We evaluated 1184 persons in two hospitals. Blood pressure was measured using automatic oscillometric devices. We selected those patients treated for hypertension. The average BP of less than 140/90 mmHg was considered a controlled BP. We found 638 hypertensive individuals, of whom 477 (75%) were receiving antihypertensive drugs, and of those, 248 (52%) had controlled BP. The prevalence of low education was more frequent in uncontrolled patients (25.3% vs. 16.1%; P < .01). We did not find association between household income, gender, and BP control. Older patients had less BP control (44% of those older than 75 years vs. 60.9% of those younger than 40; test for trend P < .05). Multivariate regression indicates low education (OR 1.71 95% CI [1.05, 2.79]; P = .03) and older age (OR 1.01; 95% IC [1.00, 1.03]) as independent predictors of the lack of BP control. We conclude that rates of BP control are low in Argentina. In a MIC with a universal health care system low education and old age but not household income are independent predictors of the lack of BP control.

[Hypertension and metabolic syndrome in HIV infected patients]. / Hipertensión y síndrome metabólico en pacientes con virus de la inmunodeficiencia-humana.

Cardiovascular diseases (CVD) are a growing cause of mortality between human immunodeficiency virus (HIV) infected patients. Hypertension (HTN) and metabolic syndrome (MS) are important causes of CVD. The prevalence of HTN and MS in HIV infected patients in Córdoba, Argentina is unknown. Our aim is to determine the prevalence of HTN and MS in HIV patients in Córdoba and their association with immunological state, inflammation and highly active antiretroviral therapy (HAART) in an observational study. Sixty-five HIV infected patients from the provincial HIV program were randomly selected. Fifty-seven (87%) were on HAART, 39 (60%) were males. The mean age was 44.7 ± 10 years. Mean CD4+ T lymphocytes (CD4+T) count was 404.4 ± 289.6 cells/ml. Viral load (VL) was undetectable in 56 (86.2%). The prevalence of HTN was 40%, and it was associated with the duration of HAART (p < 0.05). There was no association between years of HIV infection, CD4+T, VL and blood pressure. The prevalence of MS was 38.5% (25/65). MS was more frequent between those with HAART (OR: 1.80; CI 95%; 1.43-2.28; p = 0.02). Patients on HAART had higher rates of hypertriglyceridemia, impaired glucose tolerance and lower levels of HDLc (p < 0.01). MS was associated with the HAART duration (p < 0.01). HIV infected patients had a high prevalence of HTN and MS. HAART was associated with both HTN and MS, but there was no association between immunological status, VL or inflammatory markers.

La enfermedad cardiovascular y sus factores de riesgos como hipertensión arterial (HTA) y síndrome metabólico (SM), son una creciente causa de mortalidad entre los infectados con HIV. Nuestros objetivos fueron determinar la prevalencia HTA y SM en pacientes HIV positivos de la ciudad de Córdoba su asociación con el estado inmunológico, inflamación y terapia antirretroviral (TARAA). Fue un estudio aleatorizado de corte transversal. Se incluyeron 65 pacientes HIV positivos del programa provincial HIV-Córdoba, 57 (87%) recibían TARAA, 39 (60%) eran masculinos, con edad promedio de 44.7 ± 10 años. La concentración de linfocitos T CD4+ (LTCD4+) fue 404.4 ± 289.6 cel./ml. La carga viral (CV) fue indetectable en 56 (86.2%). La prevalencia de HTA fue de 40% (26/65) y se asoció a la duración de TARAA (p < 0.05). No hubo asociación entre años de infección por HIV, LTCD4+ y CV con HTA. La prevalencia de SM fue de 38.5% (25/65). El uso de TARAA fue más frecuente en aquellos con SM (OR: 1.80; IC95%: 1.43-2.28; p = 0.02). Pacientes bajo TARAA presentaron alta tasa de hipertrigliceridemia, intolerancia a la glucosa y niveles bajos de HDL (todos p < 0.01). SM se asoció a la duración de TARAA (p < 0.01). La TARAA se asoció a HTA y SM, no encontrándose relación con estado inmunológico, CV o marcadores de inflamación.

Hipertensión y síndrome metabólico en pacientes con Virus de la Inmunodeficiencia-Humana / Hypertension and metabolic syndrome in HIV infected patients

Resumen La enfermedad cardiovascular y sus factores de riesgos como hipertensión arterial (HTA) y síndrome metabólico (SM), son una creciente causa de mortalidad entre los infectados con HIV. Nuestros objetivos fueron determinar la prevalencia HTA y SM en pacientes HIV positivos de la ciudad de Córdoba su asociación con el estado inmunológico, inflamación y terapia antirretroviral (TARAA). Fue un estudio aleatorizado de corte transversal. Se incluyeron 65 pacientes HIV positivos del programa provincial HIV-Córdoba, 57 (87%) recibían TARAA, 39 (60%) eran masculinos, con edad promedio de 44.7 ± 10 años. La concentración de linfocitos T CD4+ (LTCD4+) fue 404.4 ± 289.6 cel./ml. La carga viral (CV) fue indetectable en 56 (86.2%). La prevalencia de HTA fue de 40% (26/65) y se asoció a la duración de TARAA (p < 0.05). No hubo asociación entre años de infección por HIV, LTCD4+ y CV con HTA. La prevalencia de SM fue de 38.5% (25/65). El uso de TARAA fue más frecuente en aquellos con SM (OR: 1.80; IC95%: 1.43-2.28; p = 0.02). Pacientes bajo TARAA presentaron alta tasa de hipertrigliceridemia, intolerancia a la glucosa y niveles bajos de HDL (todos p < 0.01). SM se asoció a la duración de TARAA (p < 0.01). La TARAA se asoció a HTA y SM, no encontrándose relación con estado inmunológico, CV o marcadores de inflamación.

Abstract Cardiovascular diseases (CVD) are a growing cause of mortality between human immunodeficiency virus (HIV) infected patients. Hypertension (HTN) and metabolic syndrome (MS) are important causes of CVD. The prevalence of HTN and MS in HIV infected patients in Córdoba, Argentina is unknown. Our aim is to determine the prevalence of HTN and MS in HIV patients in Córdoba and their association with immunological state, inflammation and highly active antiretroviral therapy (HAART) in an observational study. Sixty-five HIV infected patients from the provincial HIV program were randomly selected. Fifty-seven (87%) were on HAART, 39 (60%) were males. The mean age was 44.7 ± 10 years. Mean CD4+ T lymphocytes (CD4+T) count was 404.4 ± 289.6 cells/ml. Viral load (VL) was undetectable in 56 (86.2%). The prevalence of HTN was 40%, and it was associated with the duration of HAART (p < 0.05). There was no association between years of HIV infection, CD4+T, VL and blood pressure. The prevalence of MS was 38.5% (25/65). MS was more frequent between those with HAART (OR: 1.80; CI 95%; 1.43-2.28; p = 0.02). Patients on HAART had higher rates of hypertriglyceridemia, impaired glucose tolerance and lower levels of HDLc (p < 0.01). MS was associated with the HAART duration (p < 0.01). HIV infected patients had a high prevalence of HTN and MS. HAART was associated with both HTN and MS, but there was no association between immunological status, VL or inflammatory markers.

Blood Pressure Screening Campaign in Jamaica: May Measurement Month 2017.

BACKGROUND: Hypertension (HTN) is responsible for a significant disease burden in Jamaica. We are reporting the results of the 2017 blood pressure (BP) screening campaign May Measurement Month in Jamaica that aimed to increase the awareness of HTN. METHODS: Adults, 18 years old and older, from different parishes of Jamaica were invited to participate during May to June 2017. Demographic data were collected. BP, weight, and height were measured and recorded. RESULTS: Five hundred sixty-six participants (n = 566) were enrolled, 91.6% (519) from urban areas, and 72.6% (410) were females. The average age was 53.7 (18-95) years old and body mass index was 28.2 ± 6.6 kg/m2. The prevalence of HTN was 47.3% (267/566), without gender or living areas differences (both P > 0.1). Prevalence of HTN was lower in those who self-identified as Interracial ethnicity, in comparison with Afro-Caribbean (33% vs. 48.3%; P = 0.04). About third of the hypertensive patients were not aware of the high BP (89/267; 35.6%). Between hypertensive patients, 64.4% (172/267) were receiving antihypertensive drugs. The rate of BP control was 32% of the hypertensive patients and 50% of those receiving antihypertensive medication. Significant lower BP control was observed between diabetic vs. nondiabetic patients (34.3% vs. 60%; P < 0.001). CONCLUSION: We found a high prevalence of HTN in this population, especially in patients with diabetes or previous cardiovascular diseases. We report an increase in HTN awareness in Jamaica but more advances need to be performed to increase HTN treatment and control.

May Measurement Month 2017: analysis of the blood pressure screening results in Argentina-Americas.

Hypertension is a growing concern worldwide, causing over 10 million deaths each year. The prevalence of high blood pressure (BP) in Argentina is 36.3% and 38% of these are unaware of their disease. Half of the hypertensive patients are on pharmacological treatment and only a quarter of them are controlled. The International Society of Hypertension initiated the May Measurement Month (MMM) as a global campaign to raise awareness on high BP that may also serve as a temporary solution to the lack of global screening programs worldwide. A volunteer cross-sectional survey was carried out in May 2017 across 56 health centres. Blood pressure measurement, definition of hypertension and statistical analysis followed the MMM protocol. For this awareness campaign, the Argentine Society of Hypertension coined the slogan: 'Know and control your blood pressure'. A total of 32 346 individuals aged at least 18 years were screened during MMM17. After imputation, 16 263 (50.4%) were hypertensive. Of the 12 156 receiving antihypertensive medication 5400 (44.4%) still had uncontrolled BP. MMM17, called in our country 'Know and control your blood pressure', was the largest BP screening campaign done in Argentina. Almost 6 out of 10 hypertensive patients were either not on treatment or were not controlled to the BP goal. These results suggest that appropriate screening can help to identify a significant number of people with high BP.

Oral vitamin D3 5000 IU/day as an adjuvant in the treatment of atopic dermatitis: a randomized control trial.

BACKGROUND: Vitamin D has immunomodulatory effects both in the innate and adaptive immune systems, and there is growing scientific evidence demonstrating its relevance in inflammatory processes such as AD. HYPOTHESIS: If vitamin D3 promotes the skin immune system, then it should improve the response to treatment of patients with AD. METHODS: A randomized, double-blind placebo-controlled clinical trial was conducted, which included 65 patients with AD according to Hanifin-Rajka criteria and the severity scale (SCORAD). The patients were divided into two groups to receive either vitamin D3 5000 IU/day (n = 33) or placebo (n = 32), plus baseline therapy (topical steroid, soap substitute, and emollient) during 3 months. RESULTS: Fifty-eight of the 65 enrolled subjects were included in the analysis. At the end of the intervention, the treated group achieved higher levels of 25(OH)D (P < 0.001). At week 12, those patients who registered serum levels of 25(OH)D ≥20 ng/ml, regardless of whether or not they had received supplementation, showed a lower SCORAD compared to those with levels <20 ng/ml (P < 0.001). Eighty percent of the patients with serum levels <20 ng/ml (n = 9) had moderate-severe AD despite standard treatment. Vitamin D levels ≥20 ng/ml associated with baseline therapy strongly favored remission of atopic dermatitis (P = 0.03). No significant differences were found between patients with serum levels of ≥20 ng/ml vs. ≥30 ng/ml. CONCLUSIONS: Reaching serum levels of 25(OH)D > 20 ng/ml in conjunction with standard therapy is sufficient to achieve a reduction in severity (SCORAD) in patients with AD.

Primeras 2000 colecistectomías laparoscópicas ambulatorias en modalidad free-standing en un hospital público de la Argentina / Outcome of the first 2000 ambulatory, laparoscopic cholecystectomies with free-standing modality in a public hospital of Argentina

Antecedentes: la cirugía ambulatoria surge debido al aumento de la demanda y del gasto sanitario. Permite reducir el costo por procedimiento y la mayor eficacia se obtiene con la adopción de una unidad independiente pero que forma parte de un sistema de salud. Objetivo: Comunicar los primeros 2000 casos de colecistectomía laparoscópica ambulatoria en forma sistemática, en el primer hospital público independiente (free-standing) de la Argentina. Material y métodos: en 36 meses se realizaron las primeras 2000 colecistectomías laparoscópicas ambulatorias en régimen independiente (free-standing). Todos los casos fueron pacientes con patología no aguda, con IMC <35 kg/m², edad entre 13 y 65 años, categorizados ASA I o II. Resultados: se realizaron 1766 colecistectomías laparoscópicas convencionales y 234 colecistectomías mínimamente invasivas transumbilicales. Fueron trasladados a otras instituciones 12 pacientes, 3 de ellos por retardo en la recuperación y 9 por hallazgos intraoperatorios. Se diagnosticaron 3 litiasis coledocianas, 1 litiasis única y 2 múltiples durante la cirugía. Cuatro pacientes requirieron cirugía en otras instituciones por complicaciones asociadas con el procedimiento inicial. Conclusión: la colecistectomía laparoscópica en un hospital público free-standing es un proceso seguro, con tasas de complicaciones bajas si se usan los criterios de selección adecuados. La experiencia ganada con esta numerosa serie permitió afinar el sistema de selección y tratamiento.

Background: ambulatory surgery arose due to the increased demand and health expenses, allowing to reduce the cost per procedure. Efficiency may be maximized by adoption of an independent unit, but as part of a health system. Objective: to report the first 2000 cases of systematic, ambulatory laparoscopic cholecystectomies in the first public independent hospital (free-standing) of Argentina. Material and methods: in a free-standing institution, the first 2000 ambulatory laparoscopic cholecystectomies were performed in period of 36 months. All cases were non-acute, with BMI<35kg/m², aged between 13 and 65 years, categorized as ASA I or II. Results: conventional laparoscopic cholecystectomy was carried out in 1766 cases, while a minimally invasive transumbilical technique was done in 234. Twelve patients required transference to another institution, 3 of them due to delay in recovery and 9 due to intraoperative findings. Three cases of choledochalstones were diagnosed intraoperativelly (1 with a single stone and 2 with multiple). Four patients required surgery at a different institution in the immediate postoperative period due to complications associated with the initial surgery. Conclusions: laparoscopic cholecystectomy in an ambulatory free-standing public hospitalis safe, with low complication rates,if the appropriate selection criteria isused. The experience in this large series of cases allowed refining the selection and treatment criteria.

[Prevalencia y factores de riesgo para lesiones premalignas en pacientes menores de 55 años sometidos a colonoscopia en un hospital de tercer nivel]. / Prevalence and risk factors for premalignant lesions in patients younger than 55 years old founded on colonoscopy on a tertiary center.

ANTECEDENTES: El cáncer colorrectal es causa importante de mortalidad y la colonoscopia es efectiva para reducir su incidencia y mejorar la supervivencia con la resección de las lesiones precursoras. OBJETIVO: Determinar la prevalencia, las características y la histología de las lesiones en pacientes < 55 años en un hospital de tercer nivel. MÉTODO: Se realizó un estudio retrospectivo y observacional de enero de 2010 a diciembre de 2014 en el Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, con el reporte de 555 colonoscopias y los datos clínicos de las historias hospitalarias de los pacientes incluidos en el estudio. RESULTADOS: Los hallazgos fueron lesiones premalignas en el 40% de los pacientes, con pólipos en 98 casos y con un tamaño de 5.2 mm; de ellos, el 54% se localizaron en el colon, el 24% en el sigmoides, el 27% en el recto y el 1% en el ano. En los reportes se observó una prevalencia del 63% de pólipos neoplásicos (riesgo relativo [RR]: 2.3; intervalo de confianza del 95% [IC 95%]: 1.5-3.7) en pacientes con antecedente de tabaquismo, y del 42% (RR: 1.8; IC 95%: 1.2-2.6) con antecedente de consumo de alcohol. CONCLUSIONES: La prevalencia de lesiones premalignas es similar para los menores de 55 años. Esto indica la importancia del diagnóstico oportuno y de evitar la progresión. Sería conveniente extender el seguimiento a hospitales de segundo nivel en pacientes con factores de riesgo para ampliar lo reportado y contribuir a mejorar los resultados en la sanidad pública. BACKGROUND: Colorectal cancer is an important cause of mortality, colonoscopy is effective to reduce its incidence and improve survival with the resection of premalignant lesions. OBJECTIVE: To determine the prevalence, characteristics and histology of lesions in patients younger than 55 years of age in a tertiary hospital. METHOD: This is a retrospective observational study, we colected data at the Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, with the report of 555 colonoscopies, and clinical data from the hospital archives of medic histories of selected patients. RESULTS: Premalignant lesions were found on 40% of the patients. The findings were polyps in 98 cases with a size of 5.2 mm; 54% were located in the colon, 24% in the sigmoid, 27% in the rectum and 1% in the anus. A prevalence of 63% of neoplastic polyps was observed (RR: 2.3; 95% CI: 1.5-3.7) in smokers; and 42% (RR: 1.8; 95% CI: 1.2-2.6) in patients with alcohol consumption. CONCLUSIONS: The prevalence for premalignant lesions is similar for patients under 55 years of age. This highlights the importance of early diagnosis and avoiding progression. It would be convenient to extend the follow-up to second-level hospitals in patients with risk factors to contribute to improvement of public health system outcomes.

Estimated GFR or albuminuria: which one is really associated with resistant hypertension?

Patients with resistant hypertension belong to a very high cardiovascular risk group and have a high prevalence of target organ damage. Microalbuminuria and low estimated glomerular filtration rate are associated with resistant hypertension, and could be a cause and/or complication of hypertension. In this review, we explore the relationship between these 2 markers of kidney disease and the prevalence of resistant hypertension. We identified different phenotypes of resistant hypertension that associate with microalbuminuria and/or low estimated glomerular filtration rate. These phenotypes suggest that high sympathetic activity associated with fluid overload and endothelial dysfunction may contribute differently to the development of resistant hypertension.

Hemodynamic circulatory patterns in young patients with predominantly diastolic hypertension.

To evaluate the spectrum of hemodynamic patterns in patients with isolated diastolic hypertension-predominantly diastolic hypertension, we re-analyzed a previously reported cohort of 189 non-medicated hypertensive individuals that were assessed by impedance cardiography. We selected 46 patients who were less than 50 years old and had pulse pressure less or equal than 45 mm Hg confirmed by ambulatory blood pressure monitoring. The selected cohort had a mean age of 39.7 years and was 47% men. Three distinct groups were identified: a high cardiac index (CI) "hyperdynamic" group, with normal to near normal systemic vascular resistance (SVR); an intermediate CI and SVR group; and a "vasotonic" group, with low CI and high SVR. Heart rate was similar among the three groups. Stroke volume index (SVI) was significantly higher in the hyperdynamic group (61.8, 49.7, and 39.7 mL/m(2) in the high, intermediate, and low CI groups, respectively). The hyperdynamic group had greater total arterial compliance index than the vasotonic group (1.3 ± 0.3 vs 0.92 ± 0.2 mL/m(2) mm Hg for high vs low CI, respectively; P < .001). In conclusion, isolated diastolic hypertension-predominantly diastolic hypertension patients can have diverse hemodynamic patterns that cannot be predicted based on peripherally measured blood pressure and heart rate alone. This hemodynamic complexity must be taken into account when considering the genetic and pathophysiologic mechanisms of hypertension.

Uremic pruritus in hemodialysis patients: treatment with desloratidine versus gabapentin.

INTRODUCTION: Uremic pruritus is common among dialysis patients. Effective treatments are not readily available. Early evidence with antihistamines and gabapentin indicate variable effects. OBJECTIVE: To compare the efficacy and side effects of gabapentin and desloratadine in patients with dialysis pruritus. METHODS: Prospective, open-label, cross-over clinical trial in 22 patients on chronic hemodialysis with sustained pruritus over a period of at least 60 days. After a one-week run-in period, we assigned patients to three weeks of either gabapentin 300 mg thrice weekly or desloratadine 5 mg thrice weekly. After a one-week washout period, each patient crossed-over to the alternate regimen for three more weeks. The primary endpoint of the study was the change in the visual analogue pruritus score (VAS). RESULTS: Nineteen subjects completed the two treatment blocks and were available for analysis. VAS scores decreased with both treatments (5.95 to 4.6 with gabapentin, p = 0.07; 5.89 to 3.4 with desloratadine, p = 0.004), but only desloratadine reached statistical significance. There were no differences when comparing the final pruritus score with gabapentin and desloratadine (4.6 versus 3.4, p = 0.16) Excessive sedation was common with gabapentin. Desloratadine was well tolerated. CONCLUSION: Desloratadine provides significant relief of uremic pruritus compared with no therapy. gabapentin has marginal efficacy. Desloratadine is better tolerated than gabapentin.

Uremic pruritus in hemodialysis patients: treatment with desloratidine versus gabapentin / Prurido urêmico em pacientes em hemodiálise: tratamento com desloratidina versus gabapentina

INTRODUCTION: Uremic pruritus is common among dialysis patients. Effective treatments are not readily available. Early evidence with antihistamines and gabapentin indicate variable effects. OBJECTIVE: To compare the efficacy and side effects of gabapentin and desloratadine in patients with dialysis pruritus. METHODS: Prospective, open-label, cross-over clinical trial in 22 patients on chronic hemodialysis with sustained pruritus over a period of at least 60 days. After a one-week run-in period, we assigned patients to three weeks of either gabapentin 300 mg thrice weekly or desloratadine 5 mg thrice weekly. After a one-week washout period, each patient crossed-over to the alternate regimen for three more weeks. The primary endpoint of the study was the change in the visual analogue pruritus score (VAS). RESULTS: Nineteen subjects completed the two treatment blocks and were available for analysis. VAS scores decreased with both treatments (5.95 to 4.6 with gabapentin, p = 0.07; 5.89 to 3.4 with desloratadine, p = 0.004), but only desloratadine reached statistical significance. There were no differences when comparing the final pruritus score with gabapentin and desloratadine (4.6 versus 3.4, p = 0.16) Excessive sedation was common with gabapentin. Desloratadine was well tolerated. CONCLUSION: Desloratadine provides significant relief of uremic pruritus compared with no therapy. gabapentin has marginal efficacy. Desloratadine is better tolerated than gabapentin.

INTRODUÇÃO: Prurido urêmico é comum entre pacientes em diálise. Tratamentos eficazes não estão disponíveis até o momento. Provas recentes com anti-histamínicos e gabapentina indicam vários efeitos. OBJETIVO: Comparar a eficiência e os efeitos colaterais da gabapentina e da desloratadina em pacientes com prurido na diálise. MÉTODOS: Estudo prospectivo, aberto e comparativo com 22 pacientes em hemodiálise crônica com prurido constante durante um período de pelo menos 60 dias. Após uma semana, submetemos os pacientes a três semanas de gabapentina 300 mg, três vezes por semana, ou desloratadina 5 mg três vezes por semana. Após um período de eliminação de uma semana, os pacientes trocaram de regime por mais três semanas. O objetivo primário do estudo foi a mudança na escala visual analógica (EVA) de prurido. RESULTADOS: Dezenove indivíduos completaram os dois tratamentos e foram submetidos à análise. Os escores da EVA caíram com ambos os tratamentos (5,95 para 4,6 com gabapentina, p = 0,07; 5,89 para 3,4 com desloratadina, p = 0,004), mas somente a desloratadina teve significância estatística. Nenhuma diferença foi observada ao comparar o escore final do prurido com gabapentina e desloratadina (4,6 versus 3,4, p = 0,16). Excesso de sedação foi comum com gabapentina. A desloratadina teve alto nível de tolerância. CONCLUSÃO: A desloratadina dá alívio significante do prurido urêmico quando comparada a nenhum tratamento. A gabapentina tem eficiência marginal. A desloratadina tem maior nível de tolerância em relação à gabapentina.

Neurochemical and behavioural characterisation of alkoxyamphetamine derivatives in rats.

The clinical utility of amphetamine and amphetamine analogues has been jeopardized by a number of side effects and toxicity, partly due to complex mechanisms of action. While some of the analogues have been individually characterised, there is still need for comparative studies, in particularly on their efficacy to release dopamine and 5-hydroxytryptamine, further enlightening some of the synaptic mechanisms conveying their actions. Thus, we have compared four alkoxyamphetamine derivatives, i.e., p-methoxyamphetamine; p-methoxymethamphetamine; methylenedioxyamphetamine, methylenedioxymethamphetamine, using methamphetamine, and D-amphetamine, as reference substances, on rotational behaviour and releasing mechanisms studied with in vivo microdialysis in rats. All alkoxylated-derivatives produced a long-lasting rotational behaviour at 10 mg/kg s.c., but the reference substances produced a strong rotation already at 2 mg/kg s.c. in 6-hydroxydopamine-lesioned rats. At the concentration of 100 micromolar, the alkoxylated-derivatives were equipotent to evoke dopamine and 5-hydroxytryptamine release in rat neostriatum, while D-amphetamine and methamphetamine were more efficient on dopamine release. Pre-treatment with methamphetamine or the alkoxylated-derivatives produced a remarkable decrease of the effect of K+ -depolarisation on both dopamine and 5-hydroxytryptamine release. The insertion of a methoxy or a methylenedioxy group on the benzene ring of D-amphetamine or methamphetamine, or N-methylation of the D-amphetamine molecule alters the selectivity of the compounds. The efficacy of the alkoxylated-derivatives on dopamine and 5-hydroxytryptamine release was similar, but stimulated less dopamine release and produced less rotational behaviour than D-amphetamine and methamphetamine. The lower efficacy of K+ -depolarisation following pre-treatments with the derivatives suggests an impairment of releasable monoamine stores. The present observations can enlighten the mechanisms of action of drugs showing a high risk for abuse among young populations.

Factores predictivos de litiasis coledociana / Predictive factors of Choledocholithiasis

Antecedentes: Existen factores clínicos y ecográficos considerados predictivos de litiasis canalicular; su efectividad permitiría plantear el uso sistemático o selectivo de la colangiografía intraoperatoria. Objetivo: Correlacionar el incremento de los valores de laboratorio y ecográficos como factores predictivos con los hallazgos intraoperatorios y la colangiografía sistemática. Método: Descriptivo de corte transversal. Resultados: Se analizaron 147 historias clínicas (97 mujeres). 124 cumplieron con los criterios de inclusión. Se encontraron 24 pacientes con litiasis coledociana; de estos 10 presentaron aumento de todas las enzimas y del diámetro de la vía biliar principal por ecografía. En 5 pacientes no se encontró ningún factor predictivo y en los 9 restantes, se encontraron alteraciones de uno o más factores predictivos. Conclusiones: -Los distintos factores predictivos han mostrado en nuestros pacientes baja sensibilidad; ninguno de ellos aislado llega al 70 por ciento. -El estudio escográfico de la vía biliar ha mostrado una especificidad de 91 por ciento, pero baja sensibilidad para el diagnóstico de litiasis coledociana; esto podría estar relacionado con la tardanza en la cirugía a la que se vieron obligados algunos pacientes. -Ninguno de los factores predictivos (FAL, gGT, Bilirrubina, Ecografía) pueden reemplazar, el uso sistemático de la CIO. (AU)

Factores predictivos de litiasis coledociana / Predictive factors of Choledocholithiasis

Antecedentes: Existen factores clínicos y ecográficos considerados predictivos de litiasis canalicular; su efectividad permitiría plantear el uso sistemático o selectivo de la colangiografía intraoperatoria. Objetivo: Correlacionar el incremento de los valores de laboratorio y ecográficos como factores predictivos con los hallazgos intraoperatorios y la colangiografía sistemática. Método: Descriptivo de corte transversal. Resultados: Se analizaron 147 historias clínicas (97 mujeres). 124 cumplieron con los criterios de inclusión. Se encontraron 24 pacientes con litiasis coledociana; de estos 10 presentaron aumento de todas las enzimas y del diámetro de la vía biliar principal por ecografía. En 5 pacientes no se encontró ningún factor predictivo y en los 9 restantes, se encontraron alteraciones de uno o más factores predictivos. Conclusiones: -Los distintos factores predictivos han mostrado en nuestros pacientes baja sensibilidad; ninguno de ellos aislado llega al 70 por ciento. -El estudio escográfico de la vía biliar ha mostrado una especificidad de 91 por ciento, pero baja sensibilidad para el diagnóstico de litiasis coledociana; esto podría estar relacionado con la tardanza en la cirugía a la que se vieron obligados algunos pacientes. -Ninguno de los factores predictivos (FAL, gGT, Bilirrubina, Ecografía) pueden reemplazar, el uso sistemático de la CIO.