Quantificação de substâncias do fator de hidratação natural (NMF) do estrato córneo ex vivo em função do fototipo e idade / Ex vivo quantification of natural hydration factor (NMF) substances in the stratum corneum as a function of phototype and age

A hidratação cutânea ocorre, em parte, pelos componentes do Fator de Hidratação Natural (NMF), originados da degradação da filagrina, sendo alguns exemplos o ácido pirrolidona-carboxílico (PCA), o ácido urocânico (UCA) e a histidina (His). Estes estão presentes no estrato córneo (EC). O objetivo deste projeto de pesquisa foi determinar, por cromatografia líquida de alta eficiência (CLAE), o PCA, o UCA e a His no estrato córneo de participantes obtido por tape stripping em função do fototipo e idade do participante da pesquisa. Participantes foram selecionados em função da idade acima de 18 anos, ambos os gêneros e fototipo da pele entre I a VI, de acordo com a classificação de Fitzpatrick. As amostras do EC foram obtidas do antebraço volar por tape stripping e irradiadas artificialmente. A cromatografia líquida de alta eficiência (CLAE) foi eficaz para separação e quantificação adequada das substâncias químicas His, PCA e os isômeros de UCA (trans-UCA e cis-UCA) no estrato córneo dos participantes. O método apresentou-se seletivo e ausente de interferentes, ademais, possuiu linearidade e limites de detecção e quantificação compatíveis com os objetivos dessa investigação. No fototipo I, os níveis de His foram menores em comparação aos demais grupos. Ademais, os níveis dessa mesma substância não apresentaram diferença entre as faixas etárias. Em função da irradiação das amostras, o montante de His aumentou em todos os fototipos. Os níveis de PCA apresentaram-se menores após a irradiação em todos os fototipos de pele. Ainda, as concentrações do PCA foram mais elevadas na faixa etária de 46 a 55 anos de idade. Os níveis de concentração do isômero cis-UCA foram maiores nos participantes com fototipo III, após a irradiação UV. Os níveis de concentração do isômero trans-UCA diminuíram após a irradiação, de forma proporcional à formação de cis-UCA em todos os fototipos. A faixa etária de 46-55 anos de idade obteve níveis significativamente menores de trans-UCA e cis-UCA

Cutaneous hydration occurs, in part, by the components of the Natural Hydration Factor (MFN), originating from the degradation of filagrina, some examples being pyrrolidone-carboxylic acid (PCA), urocanic acid (UCA) and histidine (His). These are present in the stratum corneum (SC). The objective of this research project was to determine, by high efficiency liquid chromatography (HPLC), the PCA, UCA and His in the stratum corneum of participants obtained by tape stripping due to the phototype and age of the research participant. Participants were selected according to age above 18 years, both genders and skin phototype between I and VI, according to Fitzpatrick's classification. The SC samples were obtained from the volar forearm by tape stripping and artificially irradiated. High efficiency liquid chromatography (HPLC) was effective for the separation and proper quantification of the chemicals His, PCA and UCA isomers (trans-UCA and cis-UCA) in the stratum corneum of the participants. The method was selective and absent from interfering, in addition, it had linearity and limits of detection and quantification compatible with the objectives of this investigation. In phototype I, His levels were lower compared to the other groups. Moreover, the levels of this same substance showed no difference between age groups. Due to the irradiation of the samples, the amount of His increased in all phototypes. PCA levels were lower after irradiation in all skin phototypes. Furthermore, PCA concentrations were higher in the age group from 46 to 55 years of age. The concentration levels of the cis-UCA isomer were higher in participants with phototype III after UV irradiation. The concentration levels of the trans-UCA isomer decreased after irradiation, proportionally to the formation of cis-UCA in all phototypes. The age group 46-55 years of age obtained significantly lower levels of trans-UCA and cis-UCA

Resuscitation fluid types in sepsis, surgical, and trauma patients: a systematic review and sequential network meta-analyses.

BACKGROUND: Crystalloids and different component colloids, used for volume resuscitation, are sometimes associated with various adverse effects. Clinical trial findings for such fluid types in different patients' conditions are conflicting. Whether the mortality benefit of balanced crystalloid than saline can be inferred from sepsis to other patient group is uncertain, and adverse effect profile is not comprehensive. This study aims to compare the survival benefits and adverse effects of seven fluid types with network meta-analysis in sepsis, surgical, trauma, and traumatic brain injury patients. METHODS: Searched databases (PubMed, EMBASE, and Cochrane CENTRAL) and reference lists of relevant articles occurred from inception until January 2020. Studies on critically ill adults requiring fluid resuscitation were included. Intervention studies reported on balanced crystalloid, saline, iso-oncotic albumin, hyperoncotic albumin, low molecular weight hydroxyethyl starch (L-HES), high molecular weight HES, and gelatin. Network meta-analyses were conducted using random-effects model to calculate odds ratio (OR) and mean difference. Risk of Bias tool 2.0 was used to assess bias. Confidence in Network Meta-Analysis (CINeMA) web application was used to rate confidence in synthetic evidence. RESULTS: Fifty-eight trials (n = 26,351 patients) were identified. Seven fluid types were evaluated. Among patients with sepsis and surgery, balanced crystalloids and albumin achieved better survival, fewer acute kidney injury, and smaller blood transfusion volumes than saline and L-HES. In those with sepsis, balanced crystalloids significantly reduced mortality more than saline (OR 0.84; 95% CI 0.74-0.95) and L-HES (OR 0.81; 95% CI 0.69-0.95) and reduced acute kidney injury more than L-HES (OR 0.80; 95% CI 0.65-0.99). However, they required the greatest resuscitation volume among all fluid types, especially in trauma patients. In patients with traumatic brain injury, saline and L-HES achieved lower mortality than albumin and balanced crystalloids; especially saline was significantly superior to iso-oncotic albumin (OR 0.55; 95% CI 0.35-0.87). CONCLUSIONS: Our network meta-analysis found that balanced crystalloids and albumin decreased mortality more than L-HES and saline in sepsis patients; however, saline or L-HES was better than iso-oncotic albumin or balanced crystalloids in traumatic brain injury patients. TRIAL REGISTRATION: PROSPERO website, registration number: CRD42018115641).

The Pre-Hospital Initial Fluid Therapy Estimate in Early Nasty Burns (PHIFTEEN B, 15-B) Guideline applied to a retrospective cohort of Intensive Care Unit patients with major burns.

BACKGROUND: Appropriate fluid administration in severe burns is a cornerstone of early burns management. The American Burns Association's (ABA) recommendation is to administer 2 mL-4 mL × burnt Body Surface Area (BSA) × weight in the first 24 h with half administered in the first eight hours. Unfortunately, the calculations involved are complex and clinicians do not estimate the BSA or weight well, which can lead to errors in the amount of fluid administered. To simplify cognitive load to calculate the fluid resuscitation of early burns, the investigators derived the PHIFTEEN B (15-B) guideline. The 15-B guideline estimates the initial hourly fluid for adults ≥ 50 kg to be: 15 mL × BSA (to the nearest 10%) AIMS: To model and determine the accuracy of the 15-B calculated based on the characteristics of a retrospective cohort of patients admitted with ≥ 20% BSA to the Royal Brisbane and Women's Hospital (RBWH) Intensive Care Unit (ICU). METHODS: The 15-B formula was retrospectively calculated on the prehospital BSA estimate on patients admitted to the RBWH ICU. In addition, the 15-B guideline was modelled against a variety of weights and BSAs. The fluid volume was deemed to be clinically significant if it was greater than 250 mL/h outside the ABA's recommendations. RESULTS: The ICU cohort consisted of 107 patients (63.2% male, median age 37 years), with a median ICU estimated BSA of 40% and a median ICU weight estimation of 80 kg. In 43.9% of the cohort, the magnitude of the proportional difference between prehospital and ICU BSA estimate was greater than 25%. The 15-B formula accurately estimated the hourly fluid for all BSA (20%-100%) and weight combinations (50 kg-140 kg) in a BSA- weight matrix. When prehospital BSA estimate was utilized, 15-B guideline accurately estimated the fluid to be given within clinically significant limits for 97.2% of cases. CONCLUSIONS: The 15-B formula is a simple, easy to calculate guideline which approximates the early fluid estimates in severely burned patients despite inaccuracy in prehospital BSA estimates.

Controversias sobre el manejo de la fluidoterapia en cirugía abdominal / Controversies in fluid management during abdominal surgery

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Classe hidratação da NANDA internacional em pacientes submetidos à hemodiálise: estudo transversal / Hydration class of NANDA international in patients undergoing hemodialysis: a cross-sectional study / Clase hidratación de la NANDA internacional en pacientes sometidos a la hemodiálisis: estudio transversal

OBJETIVO: analisar a associação dos diagnósticos de enfermagem da classe Hidratação da NANDA Internacional e seus componentes em pacientes hospitalizados submetidos à hemodiálise. MÉTODO: estudo transversal realizado com 50 pacientes em um hospital universitário de uma cidade do Nordeste do Brasil. A inferência diagnóstica foi realizada por enfermeiros especialistas. A análise ocorreu por meio da estatística descritiva e inferencial. Estudo aprovado pelo Comité de Ética sob o parecer 392.535. RESULTADOS: dos seis diagnósticos, dois associaram-se aos seus componentes - Volume de líquidos excessivo com os componentes congestão pulmonar, edema e ruídos respiratórios adventícios e disposição para equilíbrio de líquidos melhorado com expressa desejo de aumentar o equilíbrio de líquidos. DISCUSSÃO: as associações identificadas guardam relação com o volume de líquidos, alteração constante na clientela investigada.CONCLUSÃO: volume de líquidos excessivo e disposição para equilíbrio de líquidos melhorado apresentaram associação significativa com alguns de seus componentes.

AIM: to analyze the association of nursing diagnoses of the Hydration class of NANDA International and its components in hospitalized patients undergoing hemodialysis. METHOD: This is a cross-sectional study involving 50 patients at a university hospital in a city in northeastern Brazil. The diagnoses inference was performed by specialist nurses. The analysis was made through the use of descriptive and inferential statistics. The study was approved by the Ethics Committee under Opinion 392,535. RESULTS: of the six diagnoses obtained, two were associated with its components involving an excessive volume of liquid with the following features: pulmonary congestion, edema and adventitious breath sounds, and the willingness to improve the fluid balance with an expressed desire to increase it. DISCUSSION: the identified associations are related to the volume of fluid, and are constantly changing in the investigated patients. CONCLUSION: The volume of excessive liquids and the willingness to improve the fluid balance showed a significant association with some of its components.

OBJETIVO: analizar la asociación de los diagnósticos de enfermería de la clase Hidratación de la NANDA Internacional y sus componentes en pacientes hospitalizados sometidos a la hemodiálisis. MÉTODO: estudio transversal realizado con 50 pacientes en un hospital universitario de una ciudad del Nordeste de Brasil. La inferencia diagnóstica fue realizada por enfermeros especialistas. El análisis ocurrió por medio de la estadística descriptiva e inferencia. Estudio aprobado por el Comité de Ética con el parecer 392.535. RESULTADOS: de los seis diagnósticos, dos se asociaron a sus componentes - Volumen de líquidos excesivo con los componentes congestión pulmonar, edema y ruidos respiratorios adventicios y disposición para equilibrio de líquidos mejorado con expreso deseo de aumentar el equilibrio de líquidos. DISCUSIÓN: las asociaciones identificadas guardan relación con el volumen de líquidos, alteración constante en la clientela investigada. CONCLUSIÓN: Volumen de líquidos excesivo y disposición para equilibrio de líquidos mejorado presentaran asociación significativa con algunos de sus componentes.

Moisturizing effect of a cosmetic formulation containing pequi oil (Caryocar brasiliense) from the Brazilian cerrado biome

Caryocar brasiliense, popularly known in Brazil as “pequi”, is a species widely distributed in the Brazilian Cerrado. The seeds are surrounded by a woody endocarp coated with a yellow fleshy mesocarp rich in oil and vitamin A, whose oil has a useful role in the treatment of skin aging and protection of human skin against UV-induced damage and skin hydration. The aim of this study was to evaluate the effect of cosmetic formulations containing pequi oil (Caryocar brasiliense) on skin hydration, after a single application. Hydration effect assessment was performed by applying the formulations under study (Control – no formulation, vehicle, and vehicle + pequi oil) onto forearm skin of 30 human volunteers. Skin capacitance and Transepidermal Water Loss (TEWL) measurements were analyzed before, and at 1, 2 and 3 hours after, a single application. Evaluation results of a single application of the vehicle containing pequi oil showed an increase in stratum corneum water content, indicating a skin moisturizing effect. Results of the evaluation of immediate effects of TEWL demonstrated that the vehicle containing pequi oil significantly increased skin moisture during the 3 h evaluation period. The formulations containing pequi oil showed clinical efficacy, increasing stratum corneum water content and enhancing skin barrier function.

Caryocar brasiliense, popularmente conhecido como “Pequi”, é uma espécie amplamente distribuída no Cerrado Brasileiro. O fruto é composto por sementes com endocarpo rígido e lenhoso, recoberto pelo mesocarpo carnoso, amarelado, rico em óleos e vitamina A, útil na proteção da pele contra raios UV, no tratamento das marcas senis da pele, bem como na hidratação cutânea. O objetivo deste estudo foi avaliar o efeito cosmético de formulações contendo óleo de pequi (Caryocar brasiliense) na hidratação cutânea, após uma única aplicação. Este efeito foi avaliado instrumentalmente através de medidas da capacitância da pele e pela perda de água transepidérmica após 1, 2 e 3 horas de uma única aplicação das formulações em estudo (controle, veículo e veículo + óleo de pequi) na pele do antebraço de 30 voluntários. Por meio das avaliações, a formulação contendo óleo de pequi aumentou o conteúdo de água no estrato córneo após 1, 2 e 3 horas, além de diminuir a perda de água transepidérmica, aumentando, significativamente, a hidratação cutânea durante as 3 horas de avaliação. A formulação contendo óleo de pequi apresentou eficácia clínica, aumentando o conteúdo aquoso do estrato córneo, bem como promovendo o efeito barreira na pele.

Thermoanalytical studies of carbamazepine: hydration/dehydration, thermal decomposition, and solid phase transitions

Carbamazepine (CBZ), a widely used anticonvulsant drug, can crystallize and exhibits four polymorphic forms and one dihydrate. Anhydrous CBZ can spontaneously absorb water and convert to the hydrate form whose different crystallinity leads to lower biological activity. The present study was concerned to the possibility of recovering the hydrated form by heating. The thermal behavior of spontaneously hydrated carbamazepine was investigated by TG/DTG-DTA and DSC in dynamic atmospheres of air and nitrogen, which revealed that the spontaneous hydration of this pharmaceutical resulted in a Form III hydrate with 1.5 water molecules. After dehydration, this anhydrous Form III converted to Form I, which melted and decomposed in a single event, releasing isocyanic acid, as shown by evolved gas analysis using TG-FTIR. Differential scanning calorimetry analyses revealed that Form III melted and crystallized as Form I, and that subsequent cooling cycles only generated Form I by crystallization. Solid state decomposition kinetic studies showed that there was no change in the substance after the elimination of water by heating to 120 °C. Activation energies of 98 ± 2 and 93 ± 2 kJ mol-1 were found for the hydrated and dried samples, respectively, and similar profiles of activation energy as a function of conversion factor were observed for these samples.

A carbamazepina (CBZ) é um anticonvulsivante frequentemente utilizado no Brasil e em vários países. Ela apresenta quatro formas polimórficas e um diidrato. Todas as formas são ativas farmacologicamente, porém a Forma III é a preferível do ponto de vista farmacêutico, em função de suas propriedades físico-químicas. Entretanto, essa forma é altamente higroscópica, podendo converter-se ao diidrato, menos ativo biologicamente. Nesse trabalho propõe-se avaliar o comportamento térmico da forma hidratada, visando à recuperação da forma ativa, por aquecimento. Para tanto, foi feito um estudo do comportamento térmico por TG/DTG-DTA e DSC em atmosfera dinâmica de ar e nitrogênio, que evidenciou hidratação espontânea da Forma III, gerando um hidrato contendo 1,5 moléculas de água. Essa forma sofre desidratação, seguida de fusão e conversão para a Forma I. Segue-se a decomposição em uma única etapa, na qual ocorre liberação do ácido isociânico, conforme análise de gases evolvidos, por termogravimetria acoplada ao infravermelho (TG-FTIR). Estudos por calorimetria exploratória diferencial mostraram que a Forma III se funde e se cristaliza imediatamente na Forma I, durante o aquecimento. A Forma I também se funde e ciclos de aquecimento/resfriamento posteriores evidenciaram que a substância se cristaliza apenas na Forma I por resfriamento. Estudos cinéticos da decomposição, em estado sólido, mostraram que não há alteração na substância pela eliminação da água por aquecimento, sendo determinados valores de energia de ativação da ordem de 98 ± 2 e 93 ± 2 kJ mol-1, respectivamente, para a amostra hidratada e submetida à secagem, assim como perfis semelhantes nas curvas de energia de ativação em função do fator de conversão.

Immediate and long-term effects of polysaccharides-based formulations on human skin

A new trend in cosmetic formulations is the use of biotechnological raw materials as the polysaccharides from Klebsiella pneumoniae, which are supposed to enhance cell renewal, improve skin hydration and micro-relief. Botanical extracts of Myrtus communis leaves contain different sugars, which may provide the same benefits. Thus, the objective of this study was to evaluate through objective and subjective analysis the immediate and long-term effects of cosmetic formulations containing polysaccharides biotechnologically-originated and / or the ones contained in Myrtus communis extracts. Three polysaccharide-based and placebo formulations were applied on the forearm skin of 40 volunteers. Skin hydration, transepidermal water loss (TEWL), viscoelasticity and skin micro-relief measurements were made before and 2 hours after a single application and after 15 and 30 day-periods of daily applications. Answers to a questionnaire about perceptions of formulation cosmetic features constituted the subjective analysis. All polysaccharide-based formulations enhanced skin hydration. Formulations with isolated or combined active substances improved skin barrier function as compared to placebo, in the short and long term studies. Formulations containing Myrtus communis extracts had the highest acceptance. Results suggest that daily use of formulations containing these substances is important for protection of the skin barrier function.

Uma nova tendência em formulações cosméticas é a utilização de matérias-primas biotecnológicas como os polissacarídeos de Klebsiella pneumoniae, que pode aumentar a renovação celular e melhor a hidratação e micro-relevo da pele. Por outro lado, o extrato vegetal de Myrtus communis contém diferentes polissacarídeos, que também podem proporcionar benefícios à pele. Assim, o objetivo do estudo foi a avaliação dos efeitos imediatos e em longo prazo, de formulações cosméticas contendo polissacarídeos obtidos por processo biotecnológico e/ou de extrato de M. communis por meio de análises objetivas e subjetivas. Três formulações contendo os polissacarídeos e um placebo foram aplicadas na pele dos antebraços de 40 voluntários. As medidas foram realizadas antes e após 2 horas da aplicação das formulações e após 15 e 30 dias de aplicações diárias em termos de hidratação da pele, perda transepidérmica de água (TEWL), viscoelasticidade e micro-relevo da pele. Para a análise subjetiva, os voluntários responderam um questionário a fim de obter-se informações sobre a percepção relativa à qualidade de cosméticos. Todas as formulações provocaram aumento da hidratação cutânea. As formulações que continham os polissacarídeos melhoraram a função barreira da pele, em curto e em longo prazo. A formulação contendo extrato de M. communis apresentou maior aceitação. Os resultados sugerem que o uso diário dos polissacarídeos avaliados é importante na proteção da função barreira da pele.

Intravenous postoperative fluid prescriptions for children: a survey of practice.

BACKGROUND: Postoperative deaths and neurological injury have resulted from hyponatraemia associated with the use of hypotonic saline solutions following surgery. We aimed to determine the rates and types of intravenous fluids being prescribed postoperatively for children in the UK. METHODS: A questionnaire was sent to members of the British Association of Paediatric Surgeons (BAPS) and Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) based at UK paediatric centres. Respondents were asked to prescribe postoperative fluids for scenarios involving children of different ages. The study period was between May 2006 and November 2006. RESULTS: The most frequently used solution was sodium chloride 0.45% with glucose 5% although one quarter of respondents still used sodium chloride 0.18% with glucose 4%. Isotonic fluids were used by 41% of anaesthetists and 9.8% of surgeons for the older child, but fewer for infants. Standard maintenance rates or greater were prescribed by over 80% of respondents. CONCLUSION: Most doctors said they would prescribe hypotonic fluids at volumes equal to or greater than traditional maintenance rates at the time of the survey. A survey to describe practice since publication of National Patient Safety Agency (NPSA) recommendations is required.

Rice-ORS versus glucose-ORS in management of severe cholera due to Vibrio cholerae O139 Bengal: a randomized, controlled clinical trial.

This study examined the comparative efficacies of rice-based oral rehydration solution (R-ORS) and glucose-based oral rehydration solution (G-ORS) in the management of severe cholera due to Vibrio cholerae O139 Bengal that causes epidemic cholera in many developing countries. Stool culture-proved adult male patients with severe cholera due to V. cholerae O139 Bengal were randomly assigned in a 1:1 ratio to receive either R-ORS or G-ORS after their initial rehydration with intravenous (i.v.) fluid and subsequently four hours of observation. They also received the usual hospital diet and tetracycline capsules (500 mg 6 hourly for three days) immediately after their enrollment in the study. The primary outcomes for observation were stool output during the first 24 hours after intervention and treatment failure as measured by the incidence of re-institution of i.v. fluid after initiation of trial therapy and duration of diarrhoea. Of 113 patients finally included in the study, 57 received R-ORS and 56 G-ORS. The admission characteristics of the two treatment groups were comparable. No significant differences in the first 24 hours of median (inter-quartile range) stool output [179 (67-206) g/kg in R-ORS group vs 193 (80-237) g/kg in G-ORS group; p = 0.52], incidences of unscheduled i.v. fluid requirement [21% (12/57) in R-ORS group vs 25% (14/56) in G-ORS group; p = 0.78], and median (inter-quartile range) duration of diarrhoea [32 (24-48) hours in R-ORS group vs 32 (24-56) hours in G-ORS group; p = 0.64] were observed. It is concluded that rice-based ORS is effective but not superior to standard glucose-based ORS in the management of adult males with severe cholera due to V. cholerae O139 Bengal.

Diarrea aguda: tratamiento nutricional / Acute diarrhea: nutrtional treatment

El tratamiento de la diarrea aguda consistirá básicamente en rehidratación oral si existiera deshidratación, realimentación precoz y excepcionalmente farmacológico. La rehidratación debe durar 4-6 horas, que se prolonga a 8-12 horas si la deshidratación es hipernatrémica, pasando posteriormente a la fase de mantenimiento. Las soluciones de rehidratación oral son las recomendadas, usándose en países en vías de desarrollo la solución de la OMS por las pérdidas importantes de sodio en las heces y soluciones con menor contenido de sodio en los países industrializados al ser las pérdidas de sodio menores. La realimentación debe ser lo mas precoz y equilibrada posible, recoméndandose la lactancia materna si es la forma de alimentación o la fórmula sin diluir si realiza lactancia artificial. No es aconsejable sistemáticamente las fórmulas sin lactosa. El uso de probióticos mejora el cuadro. No se precisa tratamiento farmacológico y los antibióticos sólo están indicados en pacientes inmunodeprimidos, cólera, lactantes menores de 3 meses con coprocultivos bacterianos positivos, enfermedad sistémica, infección por amebas, giardias, clostridium difficile y shigella que permanece sintomática (AU)

Hipodermoclisis en pacientes con cáncer avanzado / Hypodermoclisis in patients with advantages cancer

En los últimos años se ha establecido un gran debate acerca de las consecuencias de la deshidratación en los pacientes terminales con cáncer, así como ha sido controversial la necesidad de la hidratación en este tipo de pacientes. La hipodermoclisis es una técnica sencilla y eficaz con escasos efectos secundarios, que es utilizada tanto para infusión subcutánea de fluidos como en la administración de medicamentos para el control de síntomas, especialmente para aquellos pacientes que permanecen en casa. Se han establecido las ventajas de la hipodermoclosis sobre la ruta endovenosa. La tasa de infusión depende de la tolerancia individual de los pacientes. La dosis de hialuronidasa no ha sido bien establecida, sin embargo se ha señalado que no es estrictamente necesaria en la mayoría de los pacientes