Melatonin Potentiates Exercise-Induced Increases in Skeletal Muscle PGC-1α and Optimizes Glycogen Replenishment.

Compelling evidence has demonstrated the effect of melatonin on exhaustive exercise tolerance and its modulatory role in muscle energy substrates at the end of exercise. In line with this, PGC-1α and NRF-1 also seem to act on physical exercise tolerance and metabolic recovery after exercise. However, the literature still lacks reports on these proteins after exercise until exhaustion for animals treated with melatonin. Thus, the aim of the current study was to determine the effects of acute melatonin administration on muscle PGC-1α and NRF-1, and its modulatory role in glycogen and triglyceride contents in rats subjected to exhaustive swimming exercise at an intensity corresponding to the anaerobic lactacidemic threshold (iLAn). In a randomized controlled trial design, thirty-nine Wistar rats were allocated into four groups: control (CG = 10), rats treated with melatonin (MG = 9), rats submitted to exercise (EXG = 10), and rats treated with melatonin and submitted to exercise (MEXG = 10). Forty-eight hours after the graded exercise test, the animals received melatonin (10 mg/kg) or vehicles 30 min prior to time to exhaustion test in the iLAn (tlim). Three hours after tlim the animals were euthanized, followed by muscle collection for specific analyses: soleus muscles for immunofluorescence, gluteus maximus, red and white gastrocnemius for the assessment of glycogen and triglyceride contents, and liver for the measurement of glycogen content. Student t-test for independent samples, two-way ANOVA, and Newman keuls post hoc test were used. MEXG swam 120.3% more than animals treated with vehicle (EXG; p < 0.01). PGC-1α and NRF-1 were higher in MEXG with respect to the CG (p < 0.05); however, only PGC-1α was higher for MEXG when compared to EXG. Melatonin reduced the triglyceride content in gluteus maximus, red and white gastrocnemius (F = 6.66, F = 4.51, and F = 6.02, p < 0.05). The glycogen content in red gastrocnemius was higher in MEXG than in CG (p = 0.01), but not in EXG (p > 0.05). In conclusion, melatonin was found to enhance exercise tolerance, potentiate exercise-mediated increases in PGC-1α, decrease muscle triglyceride content and increase muscle glycogen 3 h after exhaustive exercise, rapidly providing a better cellular metabolic environment for future efforts.

Early recognition of cardiac surgery-associated acute kidney injury: lack of added value of TIMP2 IGFBP7 over short-term changes in creatinine (an observational pilot study).

BACKGROUND: For the detection of cardiac surgery-associated acute kidney injury (CS-AKI), the performance of urine tissue inhibitor of metalloproteinase 2 insulin-like growth factor-binding protein 7 (TIMP2 IGFBP7) has never been compared with that of very early changes in plasma creatinine (∆pCr). We hypothesized that, in the context of perioperative haemodilution, lack of postoperative decrease in pCr would be of honourable performance for the detection of CS-AKI. We therefore aimed at comparing these biomarkers and their kinetics (primary objective). As secondary objectives, we assessed plasma neutrophil gelatinase-associated lipocalin (pNGAL), cystatin C (pCysC) and urea (pUrea). We also determined the ability of these biomarkers to early discriminate persistent from transient CS-AKI. METHODS: Patients over 75 years-old undergoing aortic valve replacement with cardiopulmonary bypass (CPB) were included in this prospective observational study. Biomarkers were measured before/after CPB and at the sixth postoperative hour (H6). RESULTS: In 65 patients, CS-AKI occurred in 27 (42%). ∆pCr from post-CPB to H6 (∆pCrpostCPB-H6): outperformed TIMP2 IGFBP7 at H6 and its intra- or postoperative changes: area under the receiver operating characteristic curve (AUCROC) of 0.84 [95%CI:0.73-0.92] vs. ≤0.67 [95%CI:0.54-0.78], p ≤ 0.03. The AUCROC of pNGAL, pCysC and pUrea did not exceed 0.72 [95%CI:0.59-0.83]. Indexing biomarkers levels for blood or urine dilution did not improve their performance. Combining TIMP2 IGFBP7 and ∆pCrpostCPB-H6 was of no evident added value over considering ∆pCrpostCPB-H6 alone. For the early recognition of persistent CS-AKI, no biomarker outperformed ∆pCrpostCPB-H6 (AUCROC = 0.69 [95%CI:0.48-0.85]). CONCLUSIONS: In this hypothesis-generating study mostly testing early detection of mild CS-AKI, there was no evident added value of the tested modern biomarkers over early minimal postoperative changes in pCr: despite the common perioperative hemodilution in the setting of cardiac surgery, if pCr failed to decline within the 6 h after CPB, the development of CS-AKI was likely. Confirmatory studies with more severe forms of CS-AKI are required.

Use of systemic lidocaine for postoperative acute pain management in single-lung transplantation: Case report / Lidocaína sistêmica para el tratamiento del dolor agudo posoperatorio en trasplante unipulmonar. Reporte de caso

Abstract Introduction: Lung transplantation is associated with severe pain, which can delay recovery. Systemic lidocaine has useful analgesic properties for managing acute pain; however, little is known on its use after lung transplantation. Due to pharmacological alterations during the postoperative period, the use of analgesics implies a demanding process to avoid toxicity, so lidocaine may play a role in this scenario. In this sense, the purpose of this case report is to present the use of systemic lidocaine as an option for acute pain management when other analgesics fail. Case presentation: The following is the case of a male patient with acute pain in the postoperative period of single-lung transplantation. Opioids and non-opioid analgesics showed limited efficacy, so systematic lidocaine was administered. Systemic administration of lidocaine was effective for pain control, functional recovery, and opioid decrease during the postoperative period. Conclusions: Systemic administration of lidocaine was a useful alternative for achieving optimal postoperative pain management in lung transplantation, since it allowed adequate analgesia and lung function recovery with decreased use of opioids. This drug may be a component of multimodal analgesia in selected patients when other options fail however, its routine use is not recommended.

Resumen Introducción. El trasplante pulmonar se asocia con dolor severo, lo que puede retrasar la recuperación del paciente. La lidocaína sistémica tiene propiedades analgésicas útiles para el manejo del dolor agudo; sin embargo, su uso después del trasplante pulmonar es poco conocido. Debido a las alteraciones farmacológicas durante el período posoperatorio, el uso de analgésicos es un proceso exigente para evitar toxicidad, por lo que la lidocaína puede tener un rol en ese contexto. En este sentido, el objetivo del presente reporte es describir el uso de lidocaína sistémica como una opción para el manejo del dolor cuando otros analgésicos han fallado. Presentación del caso. Paciente masculino con dolor severo en el posoperatorio de un trasplante unipulmonar. El uso de opioides y de analgésicos no opioides mostró una eficacia limitada, por lo que se decidió aplicar lidocaína sistémica, la cual fue efectiva para el control del dolor, la recuperación funcional y la disminución de opioides durante el período posoperatorio. Conclusiones. La lidocaína sistémica fue un fármaco útil para el manejo del dolor posoperatorio del trasplante de pulmón, ya que permitió una analgesia adecuada y una recuperación funcional pulmonar con menor uso de opioides. Este fármaco puede ser parte de la analgesia multimodal en pacientes seleccionados cuando otras opciones analgésicas han fallado; sin embargo, no se recomienda su uso rutinario.

Prevalencia de hipotiroidismo en una población dislipidémica mayor de 35 años de Manizales, Colombia / Prevalence of hypothyroidism in a dyslipidemic population over age 35 in Manizales, Colombia

Resumen Introducción. La hormona estimulante de la tiroides (TSH por Thyroid-Stimulating Hormone) actúa como reguladora de lípidos en el metabolismo y puede incidir en el desarrollo de enfermedades cardiovasculares y dislipidemias. Objetivo. Determinar la prevalencia de hipotiroidismo en pacientes mayores de 35 años diagnosticados con alguna dislipidemia, con o sin tratamiento farmacológico. Materiales y métodos. Se realizó un estudio transversal que analizó el perfil lipídico y tiroideo de 206 pacientes que presentaron alguna dislipidemia entre el 15 de enero y el 15 de junio de 2013 en una IPS de Manizales; esto, con previo consentimiento informado y diligenciamiento de encuesta. Resultados. El 81.1% de los participantes presentaron hipercolesterolemia no controlada según referencia comercial y 49% se consideraron hipercolesterolémicos para el valor de referencia ATPIII. 2 de los participantes (0.97%) presentaron hipotiroidismo clínico por sus niveles bajos de T4L y 8 (3.9%), hipotiroidismo subclínico debido a que manifestaron niveles de TSH superiores a 6.16 µUI/ml. Conclusiones. Se recomienda la valoración de los niveles de TSH en hombres y mujeres mayores de 35 años con alteraciones en el metabolismo de lípidos.

Abstract Introduction: The thyroid hormone acts as a regulator of lipids in metabolism and can affect the development of cardiovascular diseases and dyslipidemia. Objective: To determine the prevalence of hypothyroidism in patients older than 35 years, diagnosed with some dyslipidemia, with or without pharmacotherapy. Materials and methods: Cross-sectional study in which the lipid and thyroid profile of 206 patients, with some type of dyslipidemia, in a health delivery center of Manizales, was analyzed between January 15 and June 15, 2013; prior informed consent and completion of a survey were requested. Results: 81.1% of participants had hypercholesterolemia that was not controlled with a commercial reference and 49% were considered hypercholesterolemic in relation to the ATP III reference value. Two participants (0.97%) had clinical hypothyroidism caused by low levels of FT4 and 8 (3.9%) had subclinical hypothyroidism due to TSH levels greater than 6.16 μIU/ml. Conclusions: The valuation of TSH levels in men and women over 35, with alterations in lipid metabolism, is recommended.