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1.
PLoS One ; 15(8): e0235557, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32756564

RESUMO

AIM: Fibroblast growth factor 21 (FGF21) has recently been implicated in thirst in rodent models. The mechanisms for this are currently uncertain, and it is unclear whether hydration status can alter FGF21 concentrations, potentially providing an additional mechanism by which hypohydration induces thirst. The aim of this study is therefore to understand whether hydration status can alter circulating FGF21 in humans. METHODS: Using a heat tent and fluid restriction, we induced hypohydration (1.9% body mass loss) in 16 healthy participants (n = 8 men), and compared their glycaemic regulation to a rehydration protocol (heat tent and fluid replacement) in a randomised crossover design. RESULTS: After the hypohydration procedure, urine specific gravity, urine and serum osmolality, and plasma copeptin (as a marker for arginine vasopressin) increased as expected, with no change after the rehydration protocol. In the fasted state, the median paired difference in plasma FGF21 concentrations from the rehydrated to hypohydrated trial arm was -37 (interquartile range -125, 10) pg∙mL-1(P = 0.278), with average concentrations being 458 ± 462 pg∙mL-1 after hypohydration and 467 ± 438 pg∙mL-1 after rehydration; mean difference -9 ± 173 pg∙mL-1. CONCLUSION: To our knowledge, these are the first causal data in humans investigating hydration and FGF21, demonstrating that an acute bout of hypohydration does not impact fasted plasma FGF21 concentrations. These data may suggest that whilst previous research has found FGF21 administration can induce thirst and drinking behaviours, a physiological state implicated in increased thirst (hypohydration) does not appear to impact plasma FGF21 concentrations in humans.


Assuntos
Desidratação/sangue , Fatores de Crescimento de Fibroblastos/sangue , Adulto , Estudos Cross-Over , Desidratação/fisiopatologia , Desidratação/terapia , Comportamento de Ingestão de Líquido , Jejum/sangue , Feminino , Hidratação , Humanos , Masculino , Sede , Adulto Jovem
2.
Rev Lat Am Enfermagem ; 28: e3321, 2020.
Artigo em Português, Espanhol, Inglês | MEDLINE | ID: mdl-32696920

RESUMO

OBJECTIVE: to elaborate, validate and evaluate the reliability of the Safety Protocol for Pediatric Thirst Management in the immediate postoperative period. METHOD: methodological quantitative research, based on the assumptions on measurement instrument development. The protocol was elaborated after literature review, interview with specialists and observation of the child's anesthetic recovery. The judges performed theoretical validation through apparent, semantic and content analysis. Content Validity Index was calculated for content validation, whose minimum established concordance was 0.80. Protocol's reliability was evaluated in children between three and 12 years old in the Post Anesthesia Care Unit. RESULTS: in its final version, the protocol consisted of five evaluation criteria: level of consciousness, movement, airway protection, breathing pattern and nausea and vomiting. It presented easy comprehension and relevant content, and all indexes exceeded the minimum agreement of 0.80. Pairs of nurses applied the protocol 116 times to 58 children, resulting in a high reliability index (kappa general = 0.98) Conclusion: the unprecedented protocol developed is valid and is a useful tool for use in anesthetic recovery, aiming to assess safety for reducing the thirst of infant patients.


Assuntos
Protocolos Clínicos , Pediatria , Sede , Criança , Pré-Escolar , Humanos , Lactente , Período Pós-Operatório , Reprodutibilidade dos Testes
3.
J Crit Care ; 59: 70-75, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32570052

RESUMO

PURPOSE: To survey healthcare workers (HCW) on availability and use of personal protective equipment (PPE) caring for COVID-19 patients in the intensive care unit (ICU). MATERIALS AND METHOD: A web-based survey distributed worldwide in April 2020. RESULTS: We received 2711 responses from 1797 (67%) physicians, 744 (27%) nurses, and 170 (6%) Allied HCW. For routine care, most (1557, 58%) reportedly used FFP2/N95 masks, waterproof long sleeve gowns (1623; 67%), and face shields/visors (1574; 62%). Powered Air-Purifying Respirators were used routinely and for intubation only by 184 (7%) and 254 (13%) respondents, respectively. Surgical masks were used for routine care by 289 (15%) and 47 (2%) for intubations. At least one piece of standard PPE was unavailable for 1402 (52%), and 817 (30%) reported reusing single-use PPE. PPE was worn for a median of 4 h (IQR 2, 5). Adverse effects of PPE were associated with longer shift durations and included heat (1266, 51%), thirst (1174, 47%), pressure areas (1088, 44%), headaches (696, 28%), Inability to use the bathroom (661, 27%) and extreme exhaustion (492, 20%). CONCLUSIONS: HCWs reported widespread shortages, frequent reuse of, and adverse effects related to PPE. Urgent action by healthcare administrators, policymakers, governments and industry is warranted.


Assuntos
Infecções por Coronavirus/transmissão , Pessoal de Saúde , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Saúde do Trabalhador , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/transmissão , Adulto , África , Pessoal Técnico de Saúde , Ásia , Betacoronavirus , Europa (Continente) , Dispositivos de Proteção dos Olhos , Feminino , Luvas Protetoras , Cefaleia/etiologia , Temperatura Alta , Humanos , Unidades de Terapia Intensiva , Masculino , Máscaras/efeitos adversos , Máscaras/provisão & distribução , Pessoa de Meia-Idade , América do Norte , Enfermeiras e Enfermeiros , Oceania , Pandemias , Equipamento de Proteção Individual/efeitos adversos , Admissão e Escalonamento de Pessoal , Médicos , Dispositivos de Proteção Respiratória/efeitos adversos , Dispositivos de Proteção Respiratória/provisão & distribução , América do Sul , Vestimenta Cirúrgica , Inquéritos e Questionários , Sede
4.
Proc Natl Acad Sci U S A ; 117(24): 13750-13756, 2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32482871

RESUMO

In response to dehydration, humans experience thirst. This subjective state is fundamental to survival as it motivates drinking, which subsequently corrects the fluid deficit. To elicit thirst, previous studies have manipulated blood chemistry to produce a physiological thirst stimulus. In the present study, we investigated whether a physiological stimulus is indeed required for thirst to be experienced. Functional MRI (fMRI) was used to scan fully hydrated participants while they imagined a state of intense thirst and while they imagined drinking to satiate thirst. Subjective ratings of thirst were significantly higher for imagining thirst compared with imagining drinking or baseline, revealing a successful dissociation of thirst from underlying physiology. The imagine thirst condition activated brain regions similar to those reported in previous studies of physiologically evoked thirst, including the anterior midcingulate cortex (aMCC), anterior insula, precentral gyrus, inferior frontal gyrus, middle frontal gyrus, and operculum, indicating a similar neural network underlies both imagined thirst and physiologically evoked thirst. Analogous brain regions were also activated during imagined drinking, suggesting the neural representation of thirst contains a drinking-related component. Finally, the aMCC showed an increase in functional connectivity with the insula during imagined thirst relative to imagined drinking, implying functional connectivity between these two regions is needed before thirst can be experienced. As a result of these findings, this study provides important insight into how the neural representation of subjective thirst is generated and how it subsequently motivates drinking behavior.


Assuntos
Encéfalo/fisiologia , Sede , Adulto , Idoso , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Feminino , Humanos , Imaginação , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Água/metabolismo
5.
Am J Physiol Regul Integr Comp Physiol ; 318(6): R1027-R1035, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32292064

RESUMO

There are examples of physiological conditions under which thirst is inappropriately exaggerated, and the mechanisms for these paradoxical ingestive behaviors remain unknown. We are interested in thirst mechanisms across the female life cycle and have identified a novel mechanism through which ingestive behavior may be activated. We discovered a previously unrecognized endogenous hypothalamic peptide, phoenixin (PNX), identified physiologically relevant actions of the peptide in brain and pituitary gland to control reproductive hormone secretion in female rodents, and in the process identified the previously orphaned G protein-coupled receptor Gpr173 to be a potential receptor for the peptide. Labeled PNX binding distribution in brain parallels areas known to be important in ingestive behaviors as well in areas where gonadal steroids feedback to control estrous cyclicity (Stein LM, Tullock CW, Mathews SK, Garcia-Galiano D, Elias CF, Samson WK, Yosten GLC, Am J Physiol Regul Integr Comp Physiol 311: R489-R496, 2016). We have demonstrated upregulation of Gpr173 during puberty, fluctuations across the estrous cycle, and, importantly, upregulation during the last third of gestation. It is during this hypervolemic, hyponatremic state that both vasopressin secretion and thirst are inappropriately elevated in humans. Here, we show that central administration of PNX stimulated water drinking in both males and females under ad libitum conditions, increased water drinking after overnight fluid deprivation, and increased both water and 1.5% NaCl ingestion under fed and hydrated conditions. Importantly, losartan pretreatment blocked the effect of PNX on water drinking, and knockdown of Gpr173 by use of short interfering RNA constructs significantly attenuated water drinking in response to overnight fluid deprivation. These actions, together with the stimulatory action of PNX on vasopressin secretion, suggest that this recently discovered neuropeptide may impact the recruitment of critically important neural circuits through which ingestive behaviors and endocrine mechanisms that maintain fluid and electrolyte homeostasis are regulated.


Assuntos
Comportamento de Ingestão de Líquido/fisiologia , Hipotálamo/metabolismo , Hormônios Peptídicos/metabolismo , Receptores Acoplados a Proteínas-G/metabolismo , Sede/fisiologia , Animais , Ciclo Estral/metabolismo , Feminino , Homeostase/fisiologia , Masculino , Hormônios Peptídicos/genética , RNA Interferente Pequeno , Ratos , Ratos Sprague-Dawley , Receptores Acoplados a Proteínas-G/genética
6.
J Neurosci ; 40(10): 2069-2079, 2020 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-32005766

RESUMO

The organum vasculosum of the lamina terminalis (OVLT) contains NaCl-sensitive neurons to regulate thirst, neuroendocrine function, and autonomic outflow. The OVLT also expresses the angiotensin II (AngII) type1 receptor, and AngII increases Fos expression in OVLT neurons. The present study tested whether individual OVLT neurons sensed both NaCl and AngII to regulate thirst and body fluid homeostasis. A multifaceted approach, including in vitro whole-cell patch recordings, in vivo single-unit recordings, and optogenetic manipulation of OVLT neurons, was used in adult, male Sprague Dawley rats. First, acute intravenous infusion of hypertonic NaCl or AngII produced anatomically distinct patterns of Fos-positive nuclei in the OVLT largely restricted to the dorsal cap versus vascular core, respectively. However, in vitro patch-clamp recordings indicate 66% (23 of 35) of OVLT neurons were excited by bath application of both hypertonic NaCl and AngII. Similarly, in vivo single-unit recordings revealed that 52% (23 of 44) of OVLT neurons displayed an increased discharge to intracarotid injection of both hypertonic NaCl and AngII. In marked contrast to Fos immunoreactivity, neuroanatomical mapping of Neurobiotin-filled cells from both in vitro and in vivo recordings revealed that NaCl- and AngII-responsive neurons were distributed throughout the OVLT. Next, optogenetic excitation of OVLT neurons stimulated thirst but not salt appetite. Conversely, optogenetic inhibition of OVLT neurons attenuated thirst stimulated by hypernatremia or elevated AngII but not hypovolemia. Collectively, these findings provide the first identification of individual OVLT neurons that respond to both elevated NaCl and AngII concentrations to regulate thirst and body fluid homeostasis.SIGNIFICANCE STATEMENT Body fluid homeostasis requires the integration of neurohumoral signals to coordinate behavior, neuroendocrine function, and autonomic function. Extracellular NaCl concentrations and the peptide hormone angiotensin II (AngII) are two major neurohumoral signals that regulate body fluid homeostasis. Herein, we present the first compelling evidence that individual neurons located in the organum vasculosum of the lamina terminalis detect both NaCl and AngII. Furthermore, optogenetic interrogations demonstrate that these neurons play a pivotal role in the regulation of thirst stimulated by NaCl and AngII. These novel observations lay the foundation for future investigations for how such inputs as well as others converge onto unique organum vasculosum of the lamina terminalis neurons to coordinate body fluid homeostasis and contribute to disorders of fluid balance.


Assuntos
Angiotensina II/metabolismo , Hipernatremia/metabolismo , Neurônios/fisiologia , Organum Vasculosum/fisiologia , Sede/fisiologia , Angiotensina II/farmacologia , Animais , Masculino , Ratos , Ratos Sprague-Dawley , Cloreto de Sódio/metabolismo , Cloreto de Sódio/farmacologia , Equilíbrio Hidroeletrolítico/fisiologia
7.
Cell ; 180(1): 25-32, 2020 01 09.
Artigo em Inglês | MEDLINE | ID: mdl-31923398

RESUMO

The function of central appetite neurons is instructing animals to ingest specific nutrient factors that the body needs. Emerging evidence suggests that individual appetite circuits for major nutrients-water, sodium, and food-operate on unique driving and quenching mechanisms. This review focuses on two aspects of appetite regulation. First, we describe the temporal relationship between appetite neuron activity and consumption behaviors. Second, we summarize ingestion-related satiation signals that differentially quench individual appetite circuits. We further discuss how distinct appetite and satiation systems for each factor may contribute to nutrient homeostasis from the functional and evolutional perspectives.


Assuntos
Apetite/fisiologia , Fome/fisiologia , Sede/fisiologia , Animais , Regulação do Apetite/fisiologia , Encéfalo/fisiologia , Comportamento Alimentar/fisiologia , Homeostase/fisiologia , Humanos , Fenômenos Fisiológicos do Sistema Nervoso , Neurônios/fisiologia , Saciação/fisiologia , Sódio/metabolismo
8.
Neuron ; 105(6): 1094-1111.e10, 2020 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-31955944

RESUMO

Interoception, the sense of internal bodily signals, is essential for physiological homeostasis, cognition, and emotions. While human insular cortex (InsCtx) is implicated in interoception, the cellular and circuit mechanisms remain unclear. We imaged mouse InsCtx neurons during two physiological deficiency states: hunger and thirst. InsCtx ongoing activity patterns reliably tracked the gradual return to homeostasis but not changes in behavior. Accordingly, while artificial induction of hunger or thirst in sated mice via activation of specific hypothalamic neurons (AgRP or SFOGLUT) restored cue-evoked food- or water-seeking, InsCtx ongoing activity continued to reflect physiological satiety. During natural hunger or thirst, food or water cues rapidly and transiently shifted InsCtx population activity to the future satiety-related pattern. During artificial hunger or thirst, food or water cues further shifted activity beyond the current satiety-related pattern. Together with circuit-mapping experiments, these findings suggest that InsCtx integrates visceral-sensory signals of current physiological state with hypothalamus-gated amygdala inputs that signal upcoming ingestion of food or water to compute a prediction of future physiological state.


Assuntos
Córtex Cerebral/fisiologia , Fome/fisiologia , Interocepção/fisiologia , Sede/fisiologia , Proteína Relacionada com Agouti/metabolismo , Animais , Clozapina/análogos & derivados , Clozapina/farmacologia , Sinais (Psicologia) , Feminino , Hipotálamo/fisiologia , Masculino , Camundongos , Camundongos Transgênicos , Vias Neurais/fisiologia , Imagem Óptica , Optogenética , Órgão Subfornical/fisiologia
9.
Rev. latinoam. enferm. (Online) ; 28: e3321, 2020. tab, graf
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-1115734

RESUMO

Objective: to elaborate, validate and evaluate the reliability of the Safety Protocol for Pediatric Thirst Management in the immediate postoperative period. Method: methodological quantitative research, based on the assumptions on measurement instrument development. The protocol was elaborated after literature review, interview with specialists and observation of the child's anesthetic recovery. The judges performed theoretical validation through apparent, semantic and content analysis. Content Validity Index was calculated for content validation, whose minimum established concordance was 0.80. Protocol's reliability was evaluated in children between three and 12 years old in the Post Anesthesia Care Unit. Results: in its final version, the protocol consisted of five evaluation criteria: level of consciousness, movement, airway protection, breathing pattern and nausea and vomiting. It presented easy comprehension and relevant content, and all indexes exceeded the minimum agreement of 0.80. Pairs of nurses applied the protocol 116 times to 58 children, resulting in a high reliability index (kappa general = 0.98) Conclusion: the unprecedented protocol developed is valid and is a useful tool for use in anesthetic recovery, aiming to assess safety for reducing the thirst of infant patients.


Objetivo: elaborar, validar e avaliar a fidedignidade do Protocolo de Segurança para o Manejo da Sede Pediátrica no pós-operatório imediato. Método: pesquisa metodológica, quantitativa, baseada nos pressupostos para elaboração de instrumentos de mensuração. Elaborou-se o protocolo após revisão de literatura, entrevista com especialistas e observação da recuperação anestésica da criança. Juízes realizaram a validação teórica por meio de análise aparente, semântica e de conteúdo. Calculou-se o Content Validity Index na validação de conteúdo, cuja concordância mínima estabelecida foi de 0,80. Avaliou-se a fidedignidade do protocolo em crianças entre três e 12 anos em sala de recuperação anestésica. Resultados: em sua versão final, o protocolo foi constituído por cinco critérios de avaliação: nível de consciência, movimentação, proteção de vias áreas, padrão respiratório e náusea e vômito. Apresentou fácil compreensão e conteúdo pertinente e relevante, e todos os índices superaram a concordância mínima de 0,80. Duplas de enfermeiros aplicaram o protocolo 116 vezes em 58 crianças, resultando em elevado índice de fidedignidade (kappa geral = 0,98) Conclusão: o protocolo inédito elaborado tem validade e é ferramenta útil para utilização na recuperação anestésica, visando avaliar a segurança para a redução da sede do paciente infantil.


Objetivo: elaborar, validar y evaluar la confiabilidad del Protocolo de Seguridad para el Manejo de la Sed Pediátrica en el postoperatorio inmediato. Método: investigación cuantitativa, metodológica, basada en los presupuestos para la elaboración de instrumentos de medición. El protocolo se elaboró después de la revisión de la literatura, entrevista con especialistas y observación de la recuperación anestésica del niño. Los jueces realizaron la validación teórica a través del análisis aparente, semántico y de contenido. El Content Validity Index se calculó para la validación de contenido, cuya concordancia mínima fue de 0,80. La fiabilidad del protocolo se evaluó en niños entre tres y 12 años en la sala de recuperación anestésica. Resultados: en su versión final, el protocolo consistió en cinco criterios de evaluación: nivel de conciencia, movimiento, protección de las vías respiratorias, patrón respiratorio y náuseas y vómitos. Presentó fácil comprensión, con contenido pertinente y relevante, siendo que todos los índices excedían la concordancia mínima de 0,80. Parejas de enfermeros aplicaron el protocolo 116 veces a 58 niños, lo que resultó en un índice de alta confiabilidad (kappa general = 0,98). Conclusión: el protocolo desarrollado, que reviste carácter inédito, es válido y puede considerarse como herramienta útil para su uso en la recuperación anestésica, con el objetivo de evaluar la seguridad para reducción de la sed del paciente infantil.


Assuntos
Humanos , Criança , Enfermagem de Centro Cirúrgico , Sala de Recuperação , Sede , Protocolos Clínicos , Enfermagem em Pós-Anestésico , Estudo de Validação
10.
Rev. baiana enferm ; 34: e34533, 2020. tab, graf
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1098746

RESUMO

Objetivo verificar a prevalência, intensidade e desconforto da sede do paciente cirúrgico ortopédico e as correlações com as variáveis demográficas e clínico-cirúrgicas. Método estudo transversal, quantitativo e analítico com 78 pacientes em Sala de Recuperação Pós-Anestésica de um hospital de ensino. Resultados oito pacientes (10,3%) verbalizaram sede espontaneamente. Sua intensidade média foi de 4,8 e o desconforto de 5,0. O atributo boca seca foi o mais prevalente, seguido de vontade de beber água e lábios ressecados. Intensidade associou-se significativamente a desconforto da sede no grupo de pacientes de 21 a 40 anos. Houve relação de prevalência entre presença de sede e todos os atributos da Escala de Desconforto da Sede Perioperatória, com exceção do atributo gosto ruim na boca. Conclusão a sede do paciente cirúrgico ortopédico é prevalente no período pós-operatório, de intensidade moderada, porém consideravelmente desconfortável.


Objetivo evaluar la prevalencia, la intensidad y la incomodidad de la sed del paciente ortopédico quirúrgico y las correlaciones con las variables demográficas y clínico-quirúrgicas. Método estudio transversal, cuantitativo y analítico con 78 pacientes en la Sala de Recuperación Post-Anestésica de un hospital universitario. Resultados ocho pacientes (10,3%) reportaron sed espontáneamente. Su intensidad media fue de 4,8 y la incomodidad, 5,0. El atributo boca seca fue el más frecuente, seguido por la voluntad de beber agua y labios secos. Intensidad correlacionó significativamente al malestar de la sed en el grupo de pacientes de 21 a 40 años. Hubo una relación de prevalencia entre la presencia de la sed y todos los atributos de la Escala de Incomodidad de la Sed Perioperatória, con la excepción del atributo mal sabor en la boca. Conclusión la sede del paciente ortopédico quirúrgico es frecuente en el postoperatorio, de intensidad moderada, pero muy incómodo.


Objective to assess the prevalence, intensity and discomfort of the thirst of the orthopedic surgical patient and the correlations with the demographic and clinical-surgical variables. Method cross-sectional, quantitative and analytical study with 78 patients in the Post-Anesthetic Recovery Room of a teaching hospital. Results eight patients (10.3%) reported thirst spontaneously. Its mean intensity was 4.8, and the discomfort, 5.0. The attribute dry mouth was the most prevalent, followed by desire to drink water and dried lips. Intensity correlated significantly with discomfort of thirst in the group of patients from 21 to 40 years. There was a relationship of prevalence between presence of thirst and all the attributes of the Perioperative Thirst Discomfort Scale, with the exception of the attribute bad taste in the mouth. Conclusion the thirst of the orthopedic surgical patient is prevalent in the postoperative period, with moderate intensity, but considerably uncomfortable.


Assuntos
Período Pós-Operatório , Sede , Xerostomia , Procedimentos Ortopédicos , Água , Prevalência
11.
Horm Behav ; 118: 104658, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31874139

RESUMO

The aim of the present study was to determine whether the TRPV1 channel is involved in the onset of sodium appetite. For this purpose, we used TRPV1-knockout mice to investigate sodium depletion-induced drinking at different times (2/24 h) after furosemide administration combined with a low sodium diet (FURO-LSD). In sodium depleted wild type and TRPV1 KO (SD-WT/SD-TPRV1-KO) mice, we also evaluated the participation of other sodium sensors, such as TPRV4, NaX and angiotensin AT1-receptors (by RT-PCR), as well as investigating the pattern of neural activation shown by Fos immunoreactivity, in different nuclei involved in hydromineral regulation. TPRV1 SD-KO mice revealed an increased sodium preference, ingesting a higher hypertonic cocktail in comparison with SD-WT mice. Our results also showed in SD-WT animals that SFO-Trpv4 expression increased 2 h after FURO-LSD, compared to other groups, thus supporting a role of SFO-Trpv4 channels during the hyponatremic state. However, the SD-TPRV1-KO animals did not show this early increase, and maybe as a consequence drank more hypertonic cocktail. Regarding the SFO-NaX channel expression, in both genotypes our findings revealed a reduction 24 h after FURO-LSD. In addition, there was an increase in the OVLT-NaX expression of SD-WT 24 h after FURO-LSD, suggesting the participation of OVLT-NaX channels in the appearance of sodium appetite, possibly as an anticipatory response in order to limit sodium intake and to induce thirst. Our work demonstrates changes in the expression of different osmo­sodium-sensitive channels at specific nuclei, related to the body sodium status in order to stimulate an adequate drinking.


Assuntos
Apetite/genética , Encéfalo/metabolismo , Dieta Hipossódica , Sódio na Dieta/administração & dosagem , Canais de Cátion TRPV/fisiologia , Animais , Apetite/efeitos dos fármacos , Dieta Hipossódica/efeitos adversos , Ingestão de Líquidos/efeitos dos fármacos , Ingestão de Líquidos/genética , Ingestão de Alimentos/efeitos dos fármacos , Ingestão de Alimentos/genética , Furosemida/farmacologia , Masculino , Camundongos , Camundongos da Linhagem 129 , Camundongos Endogâmicos C57BL , Camundongos Knockout , Sódio na Dieta/metabolismo , Canais de Cátion TRPV/genética , Canais de Cátion TRPV/metabolismo , Sede/efeitos dos fármacos , Sede/fisiologia
12.
Nutrients ; 11(11)2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31703247

RESUMO

The purpose of this study was to examine the perception of thirst as a marker of hydration status following prolonged exercise in the heat. Twelve men (mean ± SD; age, 23 ± 4 y; body mass, 81.4 ± 9.9 kg; height, 182 ± 9 cm; body fat, 14.3% ± 4.7%) completed two 180 min bouts of exercise on a motorized treadmill in a hot environment (35.2 ± 0.6 °C; RH, 30.0 ± 5.4%), followed by a 60 min recovery period. Participants completed a euhydrated (EUH) and hypohydrated (HYPO) trial. During recovery, participants were randomly assigned to either fluid replacement (EUHFL and HYPOFL; 10 min ad libitum consumption) or no fluid replacement (EUHNF and HYPONF). Thirst was measured using both a nine-point scale and separate visual analog scales. The percent of body mass loss (%BML) was significantly greater immediately post exercise in HYPO (HYPOFL, 3.0% ± 1.2%; HYPONF, 2.6% ± 0.6%) compared to EUH (EUHFL, 0.2% ± 0.7%; EUHNF, 0.6% ± 0.5%) trials (p < 0.001). Following recovery, there were no differences in %BML between HYPOFL and HYPONF (p > 0.05) or between EUHFL and EUHNF (p > 0.05). Beginning at minute 5 during the recovery period, thirst perception was significantly greater in HYPONF than EUHFL, EUHNF, and HYPOFL (p < 0.05). A 10 min, ad libitum consumption of fluid post exercise when hypohydrated (%BML > 2%), negated differences in perception of thirst between euhydrated and hypohydrated trials. These results represent a limitation in the utility of thirst in guiding hydration practices.


Assuntos
Desidratação , Exercício Físico/fisiologia , Sede/fisiologia , Adulto , Biomarcadores , Desidratação/diagnóstico , Desidratação/fisiopatologia , Hidratação , Temperatura Alta , Humanos , Adulto Jovem
13.
Rev Lat Am Enfermagem ; 27: e3180, 2019.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31596415

RESUMO

OBJECTIVE: to evaluate the effectiveness of menthol chewing gum, in the relief of the intensity and discomfort of the surgical patient's thirst in the preoperative period. METHOD: a randomized controlled trial, with 102 patients in the preoperative period, randomized in a control group, with usual care, and an experimental group, which received menthol gum, which was the study treatment variable. The primary clinical outcome was the variation in thirst intensity, evaluated by the Numeral Verbal Scale, and the secondary, the variation of the discomfort of thirst, evaluated by the Perioperative Thirst Discomfort Scale. Mann-Whitney test was used to compare measures between groups. The significance level adopted was of 0.05. RESULTS: menthol chewing gum significantly reduced the intensity (p <0.001), with Cohen's medium-effect d, and thirst discomfort (p <0.001), with a large-effect Cohen's d. CONCLUSION: menthol chewing gum was effective in reducing the intensity and discomfort of preoperative thirst. The strategy proved to be an innovative, feasible and safe option in the use for the surgical patient, in the management of the preoperative thirst, in elective surgeries. NCT: 03200197.


Assuntos
Goma de Mascar , Mentol/farmacologia , Sede/efeitos dos fármacos , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Período Pré-Operatório , Estatísticas não Paramétricas , Adulto Jovem
14.
Nat Neurosci ; 22(12): 2029-2039, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31659341

RESUMO

Motivational states modulate how animals value sensory stimuli and engage in goal-directed behaviors. The motivational states of thirst and hunger are represented in the brain by shared and unique neuromodulatory systems. However, it is unclear how such systems interact to coordinate the expression of appropriate state-specific behavior. We show that the activity of two brain neurons expressing leucokinin neuropeptide is elevated in thirsty and hungry flies, and that leucokinin release is necessary for state-dependent expression of water- and sugar-seeking memories. Leucokinin inhibits two types of mushroom-body-innervating dopaminergic neurons (DANs) to promote thirst-specific water memory expression, whereas it activates other mushroom-body-innervating DANs to facilitate hunger-dependent sugar memory expression. Selection of hunger- or thirst-appropriate memory emerges from competition between leucokinin and other neuromodulatory hunger signals at the level of the DANs. Therefore, coordinated modulation of the dopaminergic system allows flies to prioritize the expression of the relevant state-dependent motivated behavior.


Assuntos
Neurônios Dopaminérgicos/fisiologia , Drosophila , Fome/fisiologia , Memória/fisiologia , Neuropeptídeos/fisiologia , Sede/fisiologia , Animais , Animais Endogâmicos , Comportamento Animal/fisiologia , Sinais (Psicologia) , Feminino , Privação de Alimentos/fisiologia , Masculino , Corpos Pedunculados/fisiologia , Inibição Neural/fisiologia , Neurônios/metabolismo , Neuropeptídeos/metabolismo , Água , Privação de Água/fisiologia
15.
Crit Care Nurse ; 39(5): 21-28, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31575591

RESUMO

BACKGROUND: Thirst is prevalent among patients in intensive care units. A research-based "thirst bundle" was shown to significantly decrease thirst in these patients. OBJECTIVE: To implement a research-based thirst intervention performed by intensive care unit nurses and patients' family members. METHODS: Nurses and family members were taught the thirst intervention through video training and project team reinforcement. The intervention was performed by nurses for 123 patients and by family members for 13 patients. Thirst was measured with a numeric rating scale of 0 to 10, a word scale of 0 to 3, or "yes/no" answers, whichever was easiest for the patient. Inferential statistics were used to assess changes in thirst scores over time. Also assessed were nurse and family member burden levels, family level of satisfaction, and patient enjoyment. RESULTS: Thirst scores on the numeric rating scale decreased significantly: from a mean (SD) of 7.9 (2.0) before to 3.9 (2.7) after the intervention for nurses (P < .001); and from 9.2 (1.5) to 5.3 (2.6) for family members (n = 13; P = .002). Word scale scores also decreased significantly, from a median (interquartile range) of 3 (3-3) before to 2 (1-2) after the intervention for nurses (P < .001). Most patients (96%) reported enjoying the procedure. Median burden levels were less than 2 on a numeric rating scale of 0 to 10. CONCLUSIONS: The palliative "thirst bundle" significantly alleviated patients' thirst and resulted in little caregiver burden. Further efforts are warranted to incorporate this intervention into intensive care unit practice.


Assuntos
Enfermagem de Cuidados Críticos/normas , Família/psicologia , Unidades de Terapia Intensiva/normas , Cuidados Paliativos/métodos , Guias de Prática Clínica como Assunto , Sede , Xerostomia/enfermagem , Adulto , Idoso , Idoso de 80 Anos ou mais , California , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade
16.
BMJ Case Rep ; 12(9)2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31494590

RESUMO

A 40-year-old Caucasian man developed excessive thirst and polyuria particularly at night over the preceding 6 months. He had been taking lithium for 16 years for the treatment of bipolar affective disorder. Investigations revealed subnormal maximum urinary concentrating ability after 8 hours of water deprivation and only a borderline response of urine osmolality to exogenous desmopressin given by intramuscular injection. A plasma copeptin concentration was elevated at 23 pmol/L. These results were consistent with partial nephrogenic diabetes insipidus. He was encouraged to increase his water intake as dictated by his thirst. In addition, he received amiloride with some improvement in his symptoms. Clinicians should be aware of the risk of nephrogenic diabetes insipidus with long-term lithium use and seek confirmation by a supervised water deprivation test augmented with a baseline plasma copeptin. If increased water intake is insufficient to control symptoms, amiloride may be considered.


Assuntos
Amilorida/uso terapêutico , Antidepressivos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Diabetes Insípido Nefrogênico/tratamento farmacológico , Capacidade de Concentração Renal/efeitos dos fármacos , Lítio/uso terapêutico , Sede/fisiologia , Adulto , Antidepressivos/efeitos adversos , Transtorno Bipolar/fisiopatologia , Diabetes Insípido Nefrogênico/induzido quimicamente , Diabetes Insípido Nefrogênico/fisiopatologia , Humanos , Lítio/efeitos adversos , Masculino , Concentração Osmolar , Poliúria , Resultado do Tratamento , Privação de Água
17.
Rev. Hosp. Ital. B. Aires (2004) ; 39(3): 77-80, sept. 2019. tab.
Artigo em Espanhol | LILACS | ID: biblio-1048219

RESUMO

Antecedentes y objetivo: el ayuno preoperatorio disminuye el riesgo de aspiración del contenido gástrico y sus complicaciones. Sin embargo, si es excesivo, favorece la regurgitación y el riesgo de broncoaspiración tras la inducción anestésica, así como alteraciones metabólicas e hidroelectrolíticas. Analizamos su duración, en pacientes con cirugías programadas en un hospital público de agudos. Material y métodos: se encuestó a todos los pacientes mayores de 18 años con cirugías programadas. Se recolectaron datos sobre la prescripción médica de ayuno, la hora de inducción anestésica y personales. El ayuno prescripto se comparó con las recomendaciones de las guías de la AAARBA (Asociación de Anestesia, Analgesia y Reanimación de Buenos Aires). Resultados: se reclutaron 139 pacientes, con una mediana de edad de 48 años (30; 64), 53% femeninos. La mediana del ayuno prescripto fue de 12,5 horas tanto para sólidos como para líquidos. El ayuno para sólidos que realizaron los pacientes tuvo una mediana de 14 horas, la cual resultó significativamente mayor que la prescripción (p < 0,001). En cambio, el ayuno para líquidos tuvo una mediana de 12 horas, no hallándose una diferencia significativa (p = 0,452) con lo prescripto. En comparación con la guía de la AAARBA, el ayuno prescripto excedió la recomendación para sólidos (4,5 h) y para líquidos (10,5 h). El ayuno realizado por el paciente excedió lo prescripto para sólidos (1,5 h), mientras que para líquidos fue inferior (0,5 h). Conclusión: el ayuno preoperatorio prescripto no se adecuó a las recomendaciones actuales. Las horas de ayuno realizadas por el paciente resultaron excesivas. (AU)


Background and objective: preoperative fasting reduces the risk of aspiration of gastric contents and its complications. However, if fasting is excessive, it favours regurgitation and the risk of pulmonary aspiration in patients undergoing general anaesthetic, such as metabolic and electrolyte disorders. We analysed its duration in patients with elective surgeries in public acute care hospital. Material and methodologies: patients over 18 years old with elective surgeries were surveyed. Data about medical fasting indication, time of induction of anaesthesia and personal information was collected. The prescribed fast was compared with the recommendations of the AAARBA (Association of Anaesthesia, Analgesia and Reanimation of Buenos Aires) guidelines. Results: 139 patients were gathered with a median of 48 years old (30; 64), 53% of them were female. Fasting indication median was of 12.5 h for solids and liquids. The fasting made by the patient for solids had a median of 14 h which resulted to be significantly higher to the indication (p < 0.001). By contrast, the fasting for liquids had a median of 12 h which it did not show a significant difference (p = 0.452) with the indication. In comparison with the AAARBA guideline, the fasting indication exceeded the recommendation for solids (4.5 h) and for liquids (10.5 h). The fasting made by the patient exceeded to what was indicated for solids (1.5 h) while for liquids, it was inferior (0.5 h). Conclusion: the indicated preoperative fasting was not adequate to the current recommendations. The hours of fasting made by patient were excessive. (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Cuidados Pré-Operatórios/métodos , Jejum/metabolismo , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Ansiedade , Pneumonia/prevenção & controle , Cirurgia Geral/tendências , Sede , Jejum/fisiologia , Fome , Procedimentos Cirúrgicos Eletivos/métodos , Desidratação , Refluxo Laringofaríngeo/mortalidade , Refluxo Laringofaríngeo/prevenção & controle , Aspiração Respiratória de Conteúdos Gástricos/complicações , Hipoglicemia , Anestesia Geral/tendências
18.
Med Hypotheses ; 129: 109225, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31371074

RESUMO

The multitude of terms associated with love has given rise to a false perception of love. In this paper, only maternal and romantic love are considered. Love is usually regarded as a feeling, motivation, addiction, passion, and, above all, an emotion. This confusion has consequences in the lives of human beings, leading not only to divorces, suicides, femicides but possibly also to a number of mental illnesses and suffering. Therefore, it is crucial to first clarify what is meant by emotion, motivation and love. This work aims to finally place love within the category of physiological motivations, such as hunger, thirst, sleep, or sex, on the basis that love is also essential for human survival, especially in childhood. Love is presented from an evolutionary perspective. Some other similarities between love and other physiological motivations are pointed out, such as its importance for appropriate human development, both its ontogeny and its permanence, and the long-lasting consequences of abuse and neglect. There are summarized reasons that account for this, such as the fact that physiological motivations are essential for survival and that love is an essential motivation for the survival of human offspring. Other reasons are that minimum changes in the quantity and quality of love alters development, that there can be a variety of neurophysiological and behavioural states within a motivation, and that motivations (also love) appear and change throughout development. Also, motivations and love sometimes may lead to an addictive behaviour. Finally, it is recognized that once physiological motivations (and love) appear, they become permanent. In a third section, some potential social, cultural, clinical and scientific consequences of the proposed consideration of love as a motivation are discussed. Accordingly, love's recognition as a motivation in the clinical field would imply a better understanding of its disorders and its inclusion in classifications manuals such as The Diagnostic and Statistical Manual of Mental Disorders (DSM), or in the International Classification of Diseases (ICD). Considering love as a motivation rather than an emotion could also impact the results of scientific research (an example is included). A comprehensive understanding of these questions could potentially allow for a new therapeutic approach in the treatment of mental illness, while offering an all-inclusive evolutionary explanation of cultural phenomena such as the origin and diffusion of both language and art. Love should be understood as a physiological motivation, like hunger, sleep or sex, and not as an emotion as it is commonly considered.


Assuntos
Fome/fisiologia , Amor , Motivação , Comportamento Sexual , Sono/fisiologia , Sede/fisiologia , Características Culturais , Emoções/fisiologia , Humanos , Modelos Biológicos , Modelos Teóricos , Relações Mãe-Filho , Percepção , Comportamento Social
19.
Rev Bras Enferm ; 72(3): 600-608, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269122

RESUMO

OBJECTIVE: To evaluate the effectiveness of the menthol package (lip hydration and ice popsicles) compared to a package of non-menthol measures (lip hydration and ice popsicles) as a way to relieve thirst in patients in the Anesthetic Recovery Room. METHOD: Randomized and parallel trial study, with 120 patients randomized patients in an experimental group - menthol measurements (n=59) and control group - measures without menthol (n = 61). RESULTS: There was a significant (p<0.05) decrease in intensity, hydration, dryness and taste in the oral cavity between the three moments of assessment/intervention in the two groups. The difference was significant in the experimental group for thirst intensity at the second assessment/intervention point (p<0.05) after a single administration of the menthol package. CONCLUSION: There was a reduction in thirst intensity in both groups. Patients who received menthol packages showed a significant decrease in intensity after a single evaluation/intervention time. NCT: 02869139.


Assuntos
Mentol/farmacologia , Sede/efeitos dos fármacos , Adulto , Antipruriginosos/farmacologia , Antipruriginosos/uso terapêutico , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Brasil , Feminino , Humanos , Modelos Lineares , Masculino , Mentol/uso terapêutico , Pessoa de Meia-Idade , Obesidade/cirurgia , Estatísticas não Paramétricas
20.
Rev Bras Enferm ; 72(3): 818-824, 2019 Jun 07.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269151

RESUMO

OBJECTIVE: To identify, in the scientific literature, real and illusory perceptions of adult patients in induced coma. METHODS: This is an integrative review of 15 primary studies from the Medline, Web of Science, LILACS, CINAHL and SCOPUS databases. RESULTS: The main memories reported after induced coma were thirst, cold, and pain. In some studies, patients reported they were unable to tell whether they were awake or dreaming, whether it was real or unreal. Satisfactory memories were reported by patients related to the care received and the use of bedside journals. CONCLUSION: Evidence showed a number of studies aiming to identify delirium, but without a focus on analyzing real or illusory perceptions of patients after induced coma. Thus, this integrative review identified scientific evidence of memories related to perceptions of sedated patients in the intensive care unit.


Assuntos
Coma/complicações , Memória , Pacientes/psicologia , Percepção , Temperatura Baixa , Coma/psicologia , Coma/terapia , Humanos , Dor/etiologia , Dor/psicologia , Sede
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