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1.
Dev Med Child Neurol ; 62(1): 57-61, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31745987

RESUMO

AIM: To investigate if potassium citrate, a mild alkaline compound, can prevent metabolic acidosis in children with epilepsy treated with the ketogenic diet without reducing antiepileptic efficacy. METHOD: In this prospective controlled study, we investigated the frequency of initial uncompensated metabolic acidosis in 51 participants. There were 22 participants with and 29 without potassium citrate supplementation. The ketogenic diet was used as add-on treatment to children with drug resistant epilepsy. We also estimated the proportion of participants with a greater than 50% seizure reduction after 7 months. RESULTS: None of the 22 participants (15 males, seven females; median age 1y 7mo, interquartile range [IQR] 3y 3mo) with, and 10 of 29 (12 males, 17 females; median age 6y 1mo, IQR 4y 8mo) without potassium citrate developed metabolic acidosis (odds ratio=0.04, 95% CI 0.00-0.75 [p<0.01]); median pH 7.32 vs 7.24; [p<0.001]), and median bicarbonate 19.7mmol/L vs 14.0mmol/L (p<0.001). The number of seizures was reduced by more than 50% in 9 of 22 with potassium citrate and 8 of 29 participants without potassium citrate, 7 months after introducing a ketogenic diet (p=0.4). INTERPRETATION: In the ketogenic diet, potassium citrate supplementation can prevent metabolic acidosis, without reducing antiepileptic efficacy. WHAT THIS PAPER ADDS: Citrate supplementation prevents metabolic acidosis in children treated with a ketogenic diet. Efficacy of the ketogenic diet is not affected by supplementation with citrate. Citrate supplementation does not affect beta-hydroxybuturate concentration. Potassium citrate reduces the time needed to reach an optimal ketogenic ratio. This article is commented on by Schoeler on page 8 of this issue.


Assuntos
Acidose/prevenção & controle , Dieta Cetogênica , Epilepsia Resistente a Medicamentos/dietoterapia , Avaliação de Resultados em Cuidados de Saúde , Citrato de Potássio/farmacologia , Criança , Pré-Escolar , Dieta Cetogênica/efeitos adversos , Suplementos Nutricionais , Feminino , Humanos , Lactente , Masculino , Citrato de Potássio/administração & dosagem
2.
J Dairy Sci ; 103(3): 2762-2772, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31882217

RESUMO

The objectives were to nutritionally induce or blunt ruminal acidosis in young calves and to compare indicators of rumen and systemic health. Ten bull calves (n = 5/diet) were ruminally cannulated at 3 wk of age and received milk replacer and 1 of 2 calf starter diets that were designed to cause (AC; pelleted, 42.7% starch, 15.1% neutral detergent fiber, 57.8% nonfiber carbohydrates) or blunt (BL; texturized, 35.3% starch, 25.3% neutral detergent fiber, 48.1% nonfiber carbohydrates) ruminal acidosis. Mean birth weight was 38.7 ± 1.3 kg. Body weight and calf starter intake were measured weekly. Rumen contents were sampled at -8, -4, 0, 2, 4, 8, 12, and 24 h relative to starter feeding during wk 6, 8, 10, 12, 14, and 16 of age. Blood was collected from the jugular vein during the same weeks for complete blood cell count, blood pH, and partial pressures of oxygen and carbon dioxide. Rate of starter consumption was assessed during wk 16. Marker systems were used to estimate liquid passage and volatile fatty acid absorption rates. Calves were slaughtered at 17 wk, and rumen tissue was collected and assessed for papillae length, width, and degree of tissue degradation. Mean ruminal pH ± standard error was 5.37 ± 0.24 and 5.63 ± 0.24 for AC and BL calves, respectively. Lowest pH values were observed the week after weaning. Total ruminal volatile fatty acid concentrations were 131.5 and 124.8 ± 2.4 mM in AC and BL calves, respectively, and increased with age and time after feeding. Dry matter intake was lower in AC calves at wk 4 and remained lower through wk 16. Rate of starter consumption was also lower in AC calves at wk 16. Body weight also was also lower for AC calves from wk 5 through 16. Blood hemoglobin and hematocrit were lower in AC calves, but other blood characteristics were not different. Rumen volume increased with age and tended to be greater in BL calves. Passage rate and papillae length and width were not different between diets, but AC calves experienced a greater degree of tissue degradation. Ruminal acidosis symptoms in calves appear similar to those in adult cattle, and the etiology of the disease seems to follow similar mechanisms. It is clear from this study that symptoms can be moderated by diet, but further research is needed to determine whether symptoms can be nutritionally prevented or whether calves that experience ruminal acidosis are more susceptible to the disease as adults.


Assuntos
Acidose/veterinária , Ração Animal/análise , Doenças dos Bovinos/fisiopatologia , Fibras na Dieta/administração & dosagem , Ácidos Graxos Voláteis/metabolismo , Amido/administração & dosagem , Acidose/fisiopatologia , Acidose/prevenção & controle , Animais , Bovinos , Doenças dos Bovinos/prevenção & controle , Dieta/veterinária , Concentração de Íons de Hidrogênio , Masculino , Substitutos do Leite/metabolismo , Rúmen/fisiopatologia , Desmame
3.
Adv Nutr ; 10(Suppl_4): S367-S379, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31728497

RESUMO

Kidney disease affects almost 15% of the US population, and prevalence is anticipated to grow as the population ages and the obesity epidemic continues due to Western dietary practices. The densely caloric Western diet, characterized by high animal protein and low fruit and vegetable content, has fueled the growth of chronic diseases, including chronic kidney disease. The glomerulus or filtering unit of the kidney is very susceptible to barotrauma, and diets high in animal protein impede the glomerulus' ability to protect itself from hemodynamic injury. High animal protein intake combined with low intake of fruits and vegetables also leads to a high net endogenous acid production requiring augmentation of ammonium excretion in order to prevent acidosis. This higher workload of the kidney to maintain a normal serum bicarbonate level may further exacerbate kidney disease progression. This article reviews the potential mechanisms whereby several key characteristics of the typical Western diet may impact kidney disease incidence and progression. Reducing animal protein intake and egg yolk and increasing intake of fruits and vegetables and fiber may prevent or delay end-stage renal disease, but few clinical trials have examined vegetarian diets for management of chronic kidney disease. More research is needed to determine optimal dietary patterns for the prevention of kidney disease and its progression.


Assuntos
Dieta Vegetariana , Dieta Ocidental , Proteínas na Dieta/efeitos adversos , Comportamento Alimentar , Rim/efeitos dos fármacos , Insuficiência Renal Crônica , Acidose/etiologia , Acidose/prevenção & controle , Animais , Bicarbonatos/sangue , Humanos , Glomérulos Renais/efeitos dos fármacos , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/prevenção & controle
4.
Semin Nephrol ; 39(5): 473-483, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31514911

RESUMO

Intravenous crystalloid therapy is one of the most ubiquitous aspects of hospital and critical care medicine. In recent years, there has been increasing focus on the electrolyte composition, and particularly chloride content, of crystalloid solutions. This has led to increasing clinical adoption of balanced solutions, containing substrates for bicarbonate generation and consequently a lower chloride content, in place of 0.9% saline. In this article we review the physiochemical rationale for avoidance of 0.9% saline and the effects of hyperchloremic acidosis on renal physiology. Finally, we review the current evidence and rationale for use of balanced solutions greater than 0.9% saline in acutely ill patients in a variety of clinical settings, as well as considering the role for sodium bicarbonate in preventing or correcting metabolic acidosis. In conclusion, there is a strong physiological rationale for avoidance of iatrogenic hyperchloremic acidosis from 0.9% saline administration in acutely unwell patients and an association with adverse renal outcomes in several studies. However, evidence from large definitive multicenter randomized trials is not yet available to establish the dose-relationship between 0.9% saline administration and potential harm and inform us if some 0.9% saline use is acceptable or if any exposure confers harm.


Assuntos
Acidose/prevenção & controle , Lesão Renal Aguda/tratamento farmacológico , Lesão Renal Aguda/prevenção & controle , Bicarbonatos/administração & dosagem , Cloretos/administração & dosagem , Soluções Cristaloides/administração & dosagem , Acidose/induzido quimicamente , Bicarbonatos/efeitos adversos , Bicarbonatos/sangue , Cloretos/efeitos adversos , Cloretos/sangue , Humanos
5.
J Sports Sci Med ; 18(2): 271-281, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31191097

RESUMO

According to recent literature sodium bicarbonate (NaHCO3) has been proposed as a performance enhancing aid by reducing acidosis during exercise. The aim of the current review is to investigate if the duration of exercise is an essential factor for the effect of NaHCO3. To collect the latest studies from electronic database of PubMed, study publication time was restricted from December 2006 to December 2016. The search was updated in July 2018. The studies were divided into exercise durations of > 4 or ≤ 4 minutes for easier comparability of their effects in different exercises. Only randomized controlled trials were included in this review. Of the 775 studies, 35 met the inclusion criteria. Study design, subjects, effects as well as outcome criteria were inconsistent throughout the studies. Seventeen of these studies reported performance enhancing effects after supplementing NaHCO3. Eleven of twenty studies with exercise duration of ≤ 4 minutes showed positive and four diverse results after supplementing NaHCO3. On the other hand six of fifteen studies with an exercise duration of >4 minutes showed performance enhancing and two studies showed diverse results. Consequently, the duration of exercise might be influential for inducing a performance enhancing effect when supplementing NaHCO3, but to which extent, remains unclear due to the inconsistencies in the study results.


Assuntos
Acidose/prevenção & controle , Desempenho Atlético/fisiologia , Substâncias para Melhoria do Desempenho/farmacologia , Bicarbonato de Sódio/farmacologia , Atletas , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
Nephrol Ther ; 15(7): 491-497, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31056406

RESUMO

Metabolic acidosis is a frequent complication of chronic kidney disease. Although it is known to appear at advanced stages, many studies suggest a state of "global protonic retention" starting at early stages of the disease, responsible of tissue damage, particularly musculoskeletal, alteration of protidic metabolism and endocrine disorders, promoting malnutrition and chronic inflammation, and finally increasing mortality. The majority of international recommandations suggest of supplementation by alkali, most of the time by sodium bicarbonate, to struggle against this complication. An interesting alternative to correct acidosis would consist on the modulation of the endogenous production of acid by playing with the alimentary incomes. In fact, it has been demonstrated that some different types of food produce or consume protons during their metabolism. Low protein diet and rich fresh fruits and vegetables diet would manage to correct at least as well as the supplementation by sodium bicarbonate the metabolic acidosis, and to struggle against its complications, noteworthy by slowing the decline of glomerular filtration rate by limiting the toxic adaptative fibrotic mechanisms, demonstrated by the decrease of urinary tubulo-interstitial suffering markers. Of the condition of being well led, those diets do not seem to expose patients to an over-risk of malnutrition or hyperkaliemia. They therefore appear to be an attractive alternative, efficiency and safe, to fight against chronic kidney disease metabolic acidosis and its complications.


Assuntos
Acidose/dietoterapia , Insuficiência Renal Crônica/dietoterapia , Acidose/tratamento farmacológico , Acidose/etiologia , Acidose/prevenção & controle , Distúrbio Mineral e Ósseo na Doença Renal Crônica/etiologia , Distúrbio Mineral e Ósseo na Doença Renal Crônica/prevenção & controle , Terapia Combinada , Dieta com Restrição de Proteínas , Proteínas na Dieta/efeitos adversos , Proteínas na Dieta/farmacocinética , Frutas , Humanos , Hiperpotassemia/prevenção & controle , Hipoalbuminemia/etiologia , Hipoalbuminemia/prevenção & controle , Inflamação , Desnutrição/etiologia , Política Nutricional , Prótons , Insuficiência Renal Crônica/complicações , Sarcopenia/etiologia , Sarcopenia/prevenção & controle , Bicarbonato de Sódio/uso terapêutico , Verduras
7.
Curr Opin Anaesthesiol ; 32(3): 384-391, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30925513

RESUMO

PURPOSE OF REVIEW: The composition and type of intravenous fluids during paediatric anaesthesia have been subjects of debates for decades. Errors in perioperative fluid management in children may lead to serious complications and a negative outcome. Therefore, in this review, historical and recent developments and recommendations for perioperative fluid management in children are presented, based on physiology and focused on safety and efficacy. RECENT FINDINGS: Optimized fasting times and liberal clear fluid intake until 1 h improve patient comfort and metabolic and haemodynamic condition after induction of anaesthesia. Physiologically composed balanced isotonic electrolyte solutions are safer than hypotonic electrolyte solutions or saline 0.9% to protect young children against the risks of hyponatraemia and hyperchloraemic acidosis. For intraoperative maintenance infusion, addition of 1-2% glucose is sufficient to avoid hypoglycaemia, lipolysis or hyperglycaemia. Modified fluid gelatine or hydroxyethyl starch in balanced electrolyte solution can safely be used to quickly normalize blood volume in case of perioperative circulatory instability and blood loss. SUMMARY: Physiologically composed balanced isotonic electrolyte solutions are beneficial for maintaining homeostasis, shifting the status more towards the normal range in patients with preexisting imbalances and have a wide margin of safety in case of accidental hyperinfusion.


Assuntos
Anestesia/métodos , Eletrólitos/administração & dosagem , Hidratação/métodos , Soluções Isotônicas/administração & dosagem , Assistência Perioperatória/métodos , Acidose/etiologia , Acidose/prevenção & controle , Anestesia/efeitos adversos , Criança , Jejum/fisiologia , Hidratação/normas , Homeostase/fisiologia , Humanos , Hiponatremia/etiologia , Hiponatremia/prevenção & controle , Infusões Intravenosas , Assistência Perioperatória/normas
8.
J Anim Sci ; 97(3): 1347-1363, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30753501

RESUMO

The objective of this trial was to determine the benefits of supplementing active dried yeast (ADY; 3 × 1010 CFU/d of Saccharomyces cerevisiae) in diets of growing and finishing steers on ruminal pH and liver health, and evaluate the relationship of these variables with performance traits. Growing beef steers (n = 120) were blocked by weight (i.e., heavy and light) and allocated to 1 of 4 pens in an automated feed intake monitoring system. Steers were fed either control (CON; no ADY) or ADY supplemented in 4 sequential diets: grower diet from days 0 to 70, 2 step up diets (STEP1 and STEP2) for 7 d each, and finishing diet from days 85 to 164. Indwelling rumen boli were administered to monitor rumen pH during days 56 to 106 during the dietary transition. An exchange of pen assignment, within block, occurred on day 70 resulting in 4 final treatment (TRT) assignments: steers fed CON before and after the exchange (CC; n = 30), steers fed CON before and ADY after the exchange (CY; n = 30), steers fed ADY before and CON after the exchange (YC; n = 30), and steers fed ADY (YY; n = 30). Ruminal parameters were analyzed as a randomized complete block design with repeated measures of day, diet and TRT as fixed effects, and block as random effects, using 2 approaches: preliminary analysis of the means or drift analysis (DA; units change from basal values over time). Ruminal pH duration (DUR) below 6.0 (P = 0.05) and 5.8 (P = 0.05) was greater for CY steers than CC steers. Acidosis bout prevalence (pH < 5.6 for 180 consecutive minutes; P < 0.01) and bout DUR (P = 0.05) were greater for CY than other TRT groups. The DA indicated that the ruminal pH variables range, variance, and amplitude of steers in the YC group drifted further from basal pH values than CY and YY steers during the dietary transition (P ≤ 0.02), indicating that removing ADY during the dietary transition was not favorable, but including ADY may reduce ruminal fluctuation. Steers with fewer days experiencing bouts (DEB) had numerically greater ADG (P = 0.11) and tended to have greater G:F (P = 0.06). Liver abscess severity negatively affected ADG (P = 0.04). However, liver abscess severity was not affected by DEB (P = 0.90). There is evidence to suggest that the addition of the specific ADY strain in the diets of beef cattle during the dietary transition may aid in ruminal stabilization, but our study did not find evidence that acidosis bouts were related to abscess prevalence or severity.


Assuntos
Acidose/veterinária , Ração Animal/análise , Doenças dos Bovinos/prevenção & controle , Suplementos Nutricionais , Abscesso Hepático/veterinária , Fermento Seco/farmacologia , Acidose/epidemiologia , Acidose/prevenção & controle , Animais , Bovinos , Doenças dos Bovinos/epidemiologia , Dieta/veterinária , Concentração de Íons de Hidrogênio/efeitos dos fármacos , Fígado/efeitos dos fármacos , Fígado/fisiologia , Abscesso Hepático/epidemiologia , Abscesso Hepático/prevenção & controle , Pulmão/efeitos dos fármacos , Pulmão/fisiologia , Masculino , Prevalência , Distribuição Aleatória , Rúmen/metabolismo
9.
Medicine (Baltimore) ; 98(1): e13947, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30608428

RESUMO

BACKGROUND: Spinal anesthesia is the standard technique for elective cesarean section, but the incidence of maternal hypotension in this setting is reportedly about 80%, without any prophylactic management. Vasopressors are the most reliable method for counteracting the hypotension induced by spinal anesthesia. However, studies investigating the effects of vasopressors have yielded inconsistent and debatable results. Therefore, we plan to conduct a systematic review and network meta-analysis to identify the most effective vasopressor to prevent maternal hypotension, and to decrease fetal acidosis in women undergoing spinal anesthesia for elective cesarean section. METHODS: A systematic and comprehensive search to detect all the randomized controlled studies on vasopressors for the management of maternal hypotension during cesarean section under spinal anesthesia will be performed using information in the databases, MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar, beginning from their inception to October 2018. We will conduct a network meta-analysis to combine the direct and indirect comparisons of the vasopressors. We will use the surface under the cumulative ranking curve (SUCRA) values and rankograms to present the hierarchy of vasopressors. A comparison-adjusted funnel plot will be used to assess the presence of small-study effects. The quality of the studies included will be assessed using the risk of bias tool. All statistical analyses will be performed using Stata SE version 15.0. ETHICS AND DISSEMINATION: This systematic review and meta-analysis will be published in a peer-reviewed journal. Ethical approval and informed consent are not required, as the study will be a literature review and will not involve direct contact with patients or alterations to patient care. TRIAL REGISTRATION NUMBER: The protocol for this review has been registered in the PROSPERO network (registration number: CRD42018111852).


Assuntos
Raquianestesia/efeitos adversos , Cesárea/efeitos adversos , Hipotensão/tratamento farmacológico , Vasoconstritores/uso terapêutico , Acidose/prevenção & controle , Feminino , Doenças Fetais/tratamento farmacológico , Doenças Fetais/metabolismo , Humanos , Hipotensão/induzido quimicamente , Metanálise em Rede , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Vasoconstritores/administração & dosagem
10.
FASEB J ; 33(4): 4996-5004, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30596520

RESUMO

Decreases in pH (acidosis) in vitro can alter skeletal muscle mitochondrial function [respiration and reactive oxygen species (ROS) emission]. However, because skeletal muscles readily adapt to exercise, the effects of acidosis may be different on sedentary vs. trained muscle. The aim of this work was to compare the effects of pH on skeletal muscle mitochondrial function between sedentary vs. exercise-trained male Sprague-Dawley rats ( n = 10 in each cohort). Rates of mitochondrial respiration and ROS emission were determined from the soleus muscle of both cohorts over a physiologic range of pH values (pH 6.2-7.1). Exercise-trained rats had 14% higher mean muscle buffering capacities; 46 and 40% greater enzyme activity of citrate synthase and lactate dehydrogenase, respectively; and greater activity of respiratory complexes I-IV. ADP-stimulated respiration with complex I and II substrates was ∼25% greater in exercise-trained rats but was unaffected by pH in either cohort. In both cohorts, lowering pH decreased respiration only in complex I- and complex II-supported nonphosphorylating (leak) state. However, as pH decreased, ROS emissions in complex I- and complex II-supported leak state decreased only in sedentary rats; in exercise-trained rats, ROS emissions in this state remained constant. We hypothesize that this effect may result from modulation at complex III, which declined 47% per unit pH in sedentary rats, in comparison to 23% in exercise-trained rats. Taken together, these data suggest that pH regulates mitochondrial respiratory complexes and that exercise training can decrease the effects of pH on skeletal muscle mitochondrial function.-Hedges, C. P., Bishop, D. J., Hickey, A. J. R. Voluntary wheel running prevents the acidosis-induced decrease in skeletal muscle mitochondrial reactive oxygen species emission.


Assuntos
Acidose/prevenção & controle , Mitocôndrias/metabolismo , Atividade Motora/fisiologia , Músculo Esquelético/metabolismo , Condicionamento Físico Animal/métodos , Animais , Citrato (si)-Sintase/metabolismo , Concentração de Íons de Hidrogênio , Masculino , Ratos , Ratos Sprague-Dawley , Espécies Reativas de Oxigênio
11.
J Sports Sci ; 37(7): 762-771, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30319077

RESUMO

The aim of this study was to perform a systematic review and meta-analysis on the acute and chronic effects of sodium bicarbonate (NaHCO3) ingestion on Wingate performance. Following a search through PubMed, Scopus and Web of Science, 9 studies were found meeting inclusion criteria (6 acute and 3 chronic). Random-effects meta-analysis of standardized mean difference (SMD) for peak and mean power was performed. Study quality was assessed using the QualSyst. Results of the meta-analysis showed that acute ingestion of NaHCO3 did not improve Wingate test peak (weighted average effect size Hedges's g = 0.02, 95%CI: - 0.19 to 0.23, P = 0.87) or mean power (weighted average effect size Hedges's g = 0.15, 95%CI: -0.06 to 0.36, P = 0.92). However, chronic ingestion of NaHCO3 improved Wingate test peak (weighted average effect size Hedges's g = 1.21, 95%CI: 0.83 to 1.42, P = 0.001) and mean power (weighted average effect size Hedges's g = 1.26, 95%CI: 0.96 to 1.56, P = 0.001). Quality assessment of selected articles was classified as strong. This meta-analysis provides evidence that chronic, but not acute, ingestion of NaHCO3 increases both Wingate test peak and mean power.


Assuntos
Acidose/prevenção & controle , Desempenho Atlético/fisiologia , Teste de Esforço/métodos , Bicarbonato de Sódio/administração & dosagem , Administração Oral , Esquema de Medicação , Metabolismo Energético/efeitos dos fármacos , Humanos , Fadiga Muscular/fisiologia , Bicarbonato de Sódio/sangue
12.
Eur J Orthop Surg Traumatol ; 29(3): 501-508, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30317470

RESUMO

The idea of damage control (DC) is grounded on a sequential therapeutic strategy that supports physiological restoration over anatomic repair in critically injured patients. This concept is firstly described as damage control surgery (DCS) for war-wounded patients with abdominal exsanguinating trauma. The goal was to avoid prolonged operative times and prevent the outset of the lethal cycle of hypothermia, acidosis and coagulopathy. Damage control orthopedics (DCO) is also based on this concept and it is applied in the treatment of some polytrauma patients with pelvic and long bones fractures as to avoid the "second hit" of a lengthy definitive operation and eliminate initial morbidity and mortality. It is in favor of primary fracture stabilization utilizing provisional external fixation. When the patient is in stable condition, conversion to definitive open reduction and intramedullary nailing can be done. This stepwise approach should be considered as a part of the resuscitation process, and it follows the saying "do no further harm".


Assuntos
Fraturas Ósseas/cirurgia , Traumatismo Múltiplo/cirurgia , Procedimentos Ortopédicos/métodos , Lesões Relacionadas à Guerra/cirurgia , Acidose/prevenção & controle , Transtornos da Coagulação Sanguínea/prevenção & controle , Humanos , Hipotermia/prevenção & controle , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/fisiopatologia , Lesões Relacionadas à Guerra/complicações , Lesões Relacionadas à Guerra/fisiopatologia
13.
Am J Phys Anthropol ; 168(1): 170-179, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30462349

RESUMO

OBJECTIVES: Geophagy has several hypothesized functions, among them (1) detoxification of plant secondary compounds, for example, tannins, (2) buffering stomach pH to alleviate acidosis caused by high sugar intake, and (3) supplementing the diet with mineral nutrients. We tested these hypotheses in Nepal gray langurs (Semnopithecus schistaceus), a foregut fermenter for which fruits and leaves dominate the diet at different times of the year. MATERIALS AND METHODS: We collected data on feeding time per food item for 21 unprovisioned adult langurs at Ramnagar, Nepal, for 1 year using instantaneous sampling (773 observation hours). We combined these data with relative sugar and tannin content of food items to estimate diet content. We collected rainfall data to distinguish the wet season (May-September) from the dry season (October-April). We collected soil samples from consumption and control sites to test for pH and sodium, potassium, magnesium, and calcium concentrations. RESULTS: Langurs consumed soil from two sources: termite structures (in almost all months) and river banks and beds (mainly in the dry season). Soil feeding was not positively correlated with dietary tannin or sugar content (GLMM). Soil pH was not high enough to buffer stomach contents. Only sodium was significantly higher in consumed soil. DISCUSSION: The most likely function of geophagy was the acquisition of sodium. This conclusion is consistent with reports for other animals. Buffering stomach pH, an often-suggested function for animals with ruminant-like digestion, was not supported. Detoxification, often proposed for animals with a diet high in secondary compounds, was also not supported.


Assuntos
Comportamento Alimentar/fisiologia , Presbytini/fisiologia , Sódio/metabolismo , Acidose/prevenção & controle , Animais , Antropologia Física , Feminino , Concentração de Íons de Hidrogênio , Masculino , Nepal , Estações do Ano
14.
J Nephrol ; 32(1): 93-100, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30465137

RESUMO

AIMS: Cardiovascular (CV) complications are common in chronic kidney disease (CKD). Numerous metabolic disturbances including hyperphosphatemia, high circulating calciprotein particles (CPP), hyperparathyroidism, metabolic acidosis, and magnesium deficiency are associated with, and likely pathogenic for CV complications in CKD. The goal of this feasibility study was to determine whether effervescent calcium magnesium citrate (EffCaMgCit) ameliorates the aforementioned pathogenic intermediates. METHODS: Nine patients with Stage 3 and nine patients with Stage 5D CKD underwent a randomized crossover study, where they took EffCaMgCit three times daily for 7 days in one phase, and a conventional phosphorus binder calcium acetate (CaAc) three times daily for 7 days in the other phase. Two-hour postprandial blood samples were obtained on the day before and on the 7th day of treatment. RESULTS: In Stage 5D CKD, EffCaMgCit significantly increased T50 (half time for conversion of primary to secondary CPP) from baseline by 63% (P = 0.013), coincident with statistically non-significant declines in serum phosphorus by 25% and in saturation of octacalcium phosphate by 35%; CaAc did not change T50. In Stage 3 CKD, neither EffCaMgCit nor CaAc altered T50. With EffCaMgCit, a significant increase in plasma citrate was accompanied by statistically non-significant increase in serum Mg and phosphate. CaAc was without effect in any of these parameters in Stage 3 CKD. In both Stages 3 and 5D, both drugs significantly reduced serum parathyroid hormone. Only EffCaMgCit significantly increased serum bicarbonate by 3 mM (P = 0.015) in Stage 5D. CONCLUSIONS: In Stage 5D, EffCaMgCit inhibited formation of CPP, suppressed PTH, and conferred magnesium and alkali loads. These effects were unique, since they were not observed with CaAc. In Stage 3 CKD, neither of the regimens have any effect. These metabolic changes suggest that EffCaMgCit might be useful in protecting against cardiovascular complications of CKD by ameliorating pathobiologic intermediates.


Assuntos
Acidose/prevenção & controle , Citrato de Cálcio/farmacologia , Doenças Cardiovasculares/prevenção & controle , Ácido Cítrico/uso terapêutico , Hiperfosfatemia/prevenção & controle , Compostos de Magnésio/farmacologia , Deficiência de Magnésio/prevenção & controle , Compostos Organometálicos/uso terapêutico , Insuficiência Renal Crônica/tratamento farmacológico , Equilíbrio Ácido-Base/efeitos dos fármacos , Acidose/sangue , Acidose/diagnóstico , Acidose/etiologia , Idoso , Bicarbonatos/sangue , Biomarcadores/sangue , Citrato de Cálcio/uso terapêutico , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Ácido Cítrico/efeitos adversos , Ácido Cítrico/sangue , Estudos Cross-Over , Combinação de Medicamentos , Estudos de Viabilidade , Feminino , Humanos , Concentração de Íons de Hidrogênio , Hiperfosfatemia/sangue , Hiperfosfatemia/diagnóstico , Hiperfosfatemia/etiologia , Magnésio/sangue , Compostos de Magnésio/uso terapêutico , Deficiência de Magnésio/sangue , Deficiência de Magnésio/diagnóstico , Deficiência de Magnésio/etiologia , Masculino , Pessoa de Meia-Idade , Compostos Organometálicos/efeitos adversos , Compostos Organometálicos/sangue , Hormônio Paratireóideo/sangue , Fosfatos/sangue , Fósforo/sangue , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Texas , Fatores de Tempo , Resultado do Tratamento
16.
Anim Sci J ; 90(2): 189-195, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30554451

RESUMO

The effect of wood kraft pulp (KP) feed on dietary digestibility, ruminal fluid pH, rumen fermentation characteristics, and milk production performance in lactating dairy cows was examined. Four lactating dairy cows were used for the feeding experiment by the cross-over design. The control group and KP group were set up as treatments. The control group was fed total mixed ration (TMR) (40% roughage and 60% concentrate) and the KP group was fed TMR containing 12% KP that replaced half of the rolled corn in the control diet. The dry matter intake, digestibility of the feed components, and milk yield were not significantly different between control group and KP group. The number of times that the ruminal fluid pH was below 6.1 tended to decrease in the KP group compared to the control group (p < 0.10). The acetic acid ratio in the ruminal fluid of the KP group increased compared to the control group (p < 0.05) and the propionic acid ratio in the ruminal fluid of the KP group decreased compared to the control group (p < 0.05). The acetate:propionate acid ratio was increased in the KP group compared with the control group (p < 0.05). Lipopolysaccharide levels in the ruminal fluid of the KP group tended to decrease compared to the control group (p < 0.10). Based on these results, it was indicated that the use of KP feed for lactating dairy cows induced the same rumen fermentation characteristics as those in cows given a large amount of roughage without depressing milk productivity. Therefore, KP could be a valuable feed resource substitute for grains, which would also reduce the risk for subacute rumen acidosis.


Assuntos
Ração Animal , Bovinos/fisiologia , Dieta/veterinária , Fermentação/fisiologia , Lactação , Leite/metabolismo , Rúmen/metabolismo , Acidose/prevenção & controle , Acidose/veterinária , Animais , Doenças dos Bovinos/prevenção & controle , Indústria de Laticínios , Fibras na Dieta , Digestão , Feminino , Concentração de Íons de Hidrogênio , Madeira
17.
J Agric Food Chem ; 66(33): 8729-8736, 2018 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-30008219

RESUMO

We investigated the effect of sodium butyrate feeding on the disruption of ruminal epithelium barrier function in goats fed a high-concentrate diet. A total of 18 male Boer goats (live weight of 31.75 ± 1.35 kg, aged 1 year) were randomly assigned to three groups, which were fed a low-concentrate diet (LC), a high-concentrate diet (HC), or a high-concentrate diet with 1% sodium butyrate by weight (SH) for 9 weeks. We found that the pH of rumen fluid in the SH and LC groups was higher than that in the HC group. The activity of protein kinase C (PKC) kinase in the rumen epithelium was higher in the HC group than that in the LC and SH groups. The mRNA expression and phosphorylated protein levels of mitogen-activated protein kinases (MAPKs) in the rumen epithelium were lower in the SH and LC groups than those in the HC group. The DNA methylation rate of occludin was higher in the HC group than that in the SH and LC groups. The mRNA and protein expression of claudin-1, claudin-4, occludin, and zona occludin-1 was greater in the SH and LC groups than that in the HC group. In addition, sodium butyrate mitigated damage to the rumen epithelium caused by the HC diet. Together, our results suggest that the supply of sodium butyrate reverses the damage of rumen epithelium tight junction by inhibiting PKC and MAPK signaling pathways and is protective to the rumen epithelium during subacute rumen acidosis.


Assuntos
Acidose/veterinária , Ração Animal/efeitos adversos , Ácido Butírico/administração & dosagem , Epitélio/metabolismo , Doenças das Cabras/prevenção & controle , Cabras/metabolismo , Rúmen/metabolismo , Acidose/genética , Acidose/metabolismo , Acidose/prevenção & controle , Ração Animal/análise , Animais , Claudina-1/genética , Claudina-1/metabolismo , Metilação de DNA , Doenças das Cabras/genética , Doenças das Cabras/metabolismo , Cabras/genética , Concentração de Íons de Hidrogênio , Masculino , Ocludina/genética , Ocludina/metabolismo , Proteína Quinase C/genética , Proteína Quinase C/metabolismo , Rúmen/química , Junções Íntimas/genética , Junções Íntimas/metabolismo
18.
Am J Physiol Renal Physiol ; 315(3): F711-F725, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-29741098

RESUMO

Metabolic acidosis is the most common acid-base disorder in septic patients and is associated with increased mortality. Previously, we demonstrated that sepsis induced by cecal ligation and puncture (CLP) impairs [Formula: see text] absorption in the medullary thick ascending limb (MTAL) by 1) decreasing the intrinsic [Formula: see text] absorptive capacity and 2) enhancing inhibition of [Formula: see text] absorption by LPS through upregulation of Toll-like receptor (TLR) 4 signaling. Both effects depend on ERK activation. Monophosphoryl lipid A (MPLA) is a detoxified TLR4 agonist that enhances innate antimicrobial immunity and improves survival following sepsis. Pretreatment of MTALs with MPLA in vitro prevents LPS inhibition of [Formula: see text] absorption. Here we examined whether pretreatment with MPLA would protect the MTAL against sepsis. Vehicle or MPLA was administered to mice 48 h before sham or CLP surgery, and MTALs were studied in vitro 18 h postsurgery. Pretreatment with MPLA prevented the effects of sepsis to decrease the basal [Formula: see text] absorption rate and enhance inhibition by LPS. These protective effects were mediated through MPLA stimulation of a Toll/IL-1 receptor domain-containing adaptor-inducing IFN-ß-(TRIF)-dependent phosphatidylinositol 3-kinase-Akt pathway that prevents sepsis- and LPS-induced ERK activation. The effects of MPLA to improve MTAL [Formula: see text] absorption were associated with marked improvement in plasma [Formula: see text] concentration, supporting a role for the kidneys in the pathogenesis of sepsis-induced metabolic acidosis. These studies support detoxified TLR4-based immunomodulators, such as MPLA, that enhance antimicrobial responses as a safe and effective approach to prevent or treat sepsis-induced renal tubule dysfunction and identify cell signaling pathways that can be targeted to preserve MTAL [Formula: see text] absorption and attenuate metabolic acidosis during sepsis.


Assuntos
Acidose/prevenção & controle , Bicarbonatos/metabolismo , Lipídeo A/análogos & derivados , Alça do Néfron/efeitos dos fármacos , Reabsorção Renal/efeitos dos fármacos , Sepse/tratamento farmacológico , Equilíbrio Ácido-Base/efeitos dos fármacos , Acidose/metabolismo , Acidose/fisiopatologia , Proteínas Adaptadoras de Transporte Vesicular/deficiência , Proteínas Adaptadoras de Transporte Vesicular/genética , Animais , Bicarbonatos/sangue , Bicarbonatos/urina , Modelos Animais de Doenças , Ativação Enzimática , MAP Quinases Reguladas por Sinal Extracelular/metabolismo , Lipídeo A/farmacologia , Alça do Néfron/metabolismo , Alça do Néfron/fisiopatologia , Masculino , Camundongos Endogâmicos C57BL , Camundongos Knockout , Fosfatidilinositol 3-Quinase/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , Sepse/metabolismo , Sepse/fisiopatologia , Transdução de Sinais/efeitos dos fármacos , Receptor 4 Toll-Like/agonistas
19.
J Matern Fetal Neonatal Med ; 31(1): 123-127, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28027681

RESUMO

Cardiotocograph (CTG) is associated with a high false positive rate of up to 60% which may increase the risk of unnecessary intrapartum interventions (emergency caesarean sections or operative vaginal deliveries) without any significant benefits. A recent study on variation of caesarean section rates in England has concluded that there was a very wide variation even in the adjusted rates of caesarean section from 14.9% to 32.1%. Cochrane Systematic Reviews have concluded that the use of FBS does not reduce caesarean section rate or any pre-specified neonatal outcomes. Fetal ECG (ST-Analyser or STAN) has been used in the clinical practice for more than 20 years. Although, initial randomised controlled trials (RCTs) showed great promise regarding the role of STAN in reducing operative delivery rates (instrumental vaginal births and emergency caesarean sections) and neonatal metabolic acidosis, subsequent studies have questioned the role of STAN in clinical practice. A recent meta-analysis which included six randomised controlled trials (a total of 26,446 women) has concluded that there was a 36% reduction in the rate of neonatal metabolic acidosis. Practising clinicians currently face a dilemma as to whether STAN has a place in contemporary obstetric practice or whether it?s use should be discouraged and discontinued.


Assuntos
Cardiotocografia/efeitos adversos , Parto Obstétrico , Eletrocardiografia/efeitos adversos , Procedimentos Desnecessários , Acidose/prevenção & controle , Feminino , Humanos , Gravidez
20.
J Crit Care ; 43: 13-20, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28826081

RESUMO

PURPOSE: To investigate long-term effects of staff training and electronic clinical decision support (CDS) on adherence to lung-protective ventilation recommendations. MATERIALS AND METHODS: In 2012, group instructions and workshops at two surgical intensive care units (ICUs) started, focusing on standardized protocols for mechanical ventilation and volutrauma prevention. Subsequently implemented CDS functions continuously monitor ventilation parameters, and from 2015 triggered graphical notifications when tidal volume (VT) violated individual thresholds. To estimate the effects of these educational and technical interventions, we retrospectively analyzed nine years of VT records from routine care. As outcome measures, we calculated relative frequencies of settings that conform to recommendations, case-specific mean excess VT, and total ICU survival. RESULTS: Assessing 571,478 VT records from 10,241 ICU cases indicated that adherence during pressure-controlled ventilation improved significantly after both interventions; the share of conforming VT records increased from 61.6% to 83.0% and then 86.0%. Despite increasing case severity, ICU survival remained nearly constant over time. CONCLUSIONS: Staff training effectively improves adherence to lung-protective ventilation strategies. The observed CDS effect seemed less pronounced, although it can easily be adapted to new recommendations. Both interventions, which futures studies could deploy in combination, promise to improve the precision of mechanical ventilation.


Assuntos
Cuidados Críticos , Sistemas de Apoio a Decisões Clínicas , Fidelidade a Diretrizes , Capacitação em Serviço , /terapia , Acidose/prevenção & controle , Lesão Pulmonar Aguda/prevenção & controle , Idoso , Pressão Positiva Contínua nas Vias Aéreas , Cuidados Críticos/normas , Medicina Baseada em Evidências , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Atelectasia Pulmonar/prevenção & controle , Respiração Artificial/métodos , Estudos Retrospectivos , Volume de Ventilação Pulmonar
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