Intoxicación severa por Nicotiana glauca (Palán Palán) con miocardio atontado / Severe poisoning by Nicotiana glauca (Palán Palán) with stunned myocardium

Resumen Nicotiana glauca también llamada Palán Palán, es un arbusto con hojas verdes azuladas y despulidas y una flor amarilla tubular pendulante que presenta alcaloides piridínicos, como nicotina, nornicotina, anatabina y anabastina (análogo estructural de la Nicotina). Se presenta el caso clínico de una paciente de 50 años con cuadro agudo de debilidad muscular generalizada que evoluciona con paro respiratorio, tras la ingesta accidental de una cantidad desconocida de hojas de Nicotiana glauca, cultivadas en una huerta hogareña mediante técnica de hidroponía y confundidas por su conviviente con espinaca. Presentó aumento de lactato y Troponina Ultra Sensible e Hipoquinesia Global de Ventrículo Izquierdo en el ecocardiograma, compatible con Aton tamiento Miocárdico (AM), que evolucionó favorablemente. Si bien hay pocos reportes, se han informado muertes de animales y humanos, tras la ingesta accidental de Nicotiana glauca. El inicio del cuadro es rápido, con patrón bifásico, con vómitos y estímulo simpático, seguido por bloqueo ganglionar y neuromuscular, pudiendo presentar paro respiratorio, shock, convulsiones y coma. El AM es una disfunción miocárdica prolongada con retorno gradual de la actividad contráctil, posterior a un episodio breve de isquemia grave, puede ser asintomático, pudiendo presentar alteraciones en el electrocardiograma, enzimas cardíacas o ecocardiograma. Generalmente presenta pronóstico favorable, pudiendo presentar insuficiencia cardíaca ante patologías concurrentes o aumento de requerimientos de oxígeno.

Abstract Nicotiana glauca is a shrub with bluish green leaves and a pendulous tubular yellow flower. It has pyridine alkaloids, such as nicotine, nornicotine, anatabine and anabastine (structural analog of Nicotine). We present the case of a 50 years old pa- tient with acute generalized muscle weakness that evolves to respiratory arrest, after accidentally ingesting an unknown quantity of Nicotiana glauca leaves, grown in a home vegetable garden, using a hydroponic technique and confused by her cohabiting with spinach. She presented increased lactate and Ultra Sensitive Troponin and Left Ventricular Global Hypokinesia in the echo- cardiogram, compatible with Myocardial Stunned, that it evolved favorably. There are few reports, animal and human deaths have been reported following accidental ingestion of Nicotiana glauca. The onset of the symptoms is early, with a biphasic pattern, with vomiting and sympathetic stimulation, followed by ganglionic and neuromuscular blockage and may present respiratory arrest, shock, seizures and coma. Myocardial Stunned is a prolonged myocardial dysfunction with gradual return of contractile activity after a brief episode of severe ischemia, it can be asymptomatic, and it can present alterations in the electrocardiogram, cardiac enzymes or echocardiogram. Generally presents a benign prognosis, being able to present heart failure with concurrent patholo- gies or increased requirements.

Effects of quercetin on proliferation and expression of P38MAPK and HMGB1 protein in neonatal rat cardiac fibroblasts induced by TNF-α / 重庆医学

Objective To study the effect of quercetin on proliferation and expression of P38MAPK and HMGB1 protein in neonatal rat cardiac fibroblasts induced by TNF-α.Methods Purified cardiac fibroblasts were obtained by trypsin digestion and differential adherence method.The proliferation of cardiac fibroblasts was detected by MTT assay.The expression of P38MAPK and HMGB1 protein was detected by Western blot.Results Quercetin had no effect on the proliferation of cardiac fibroblasts in the basal state but inhibited the proliferation of cardiac fibroblasts induced by TNF-α,and the A value of each group was increased with the increase of quereetin concentration(P＜0.05).The exspression of P38MAPK、HMGB1 were decresed with the icrease of quercetin.Conclusion Quercetin may inhibit the proliferation of cardiac fibroblasts induced by TNF-α.The mechanism may be inhibit the expression of HMGB1 through P38MAPK signaling pathway.

Effects of different concentrations of enflurane on myocardial energy metabolism at hypothermia or normothermia / 中华麻醉学杂志

Objective To investigate the effects of enflurane (Enf)at normothermia or hypothermia on myocardial energy metabolism. Methods Twenty-four isolated rabbit hearts, perfused with modified Krebs-Hensleit buffer using Langendorff's device in 15 min, were randomly assigned to be perfused with 1. 1 % Enf at normothermia (37℃ ), 2. 2 % Enf at normothermia (37℃ ), 1. 1 % Enf at hypothermia (30℃ ), or 2. 2 % Enf at hypothermia (30 ℃ ), respectively. The myocardial adenine nucleotides contents, activities of ATPases were measured after 30min perfusion. Results In group 2.2% Enf, ATP content was significantly higher and the activity of Na+ -K+ ATPase was significantly lower than those in group 1. 1 % Enf at normothermia or hypothermia (P