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2.
PLoS One ; 16(9): e0257677, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34570811

RESUMO

Patients' medical histories are the salient dataset for diagnosis. Prior work shows consistently, however, that medical history-taking by physicians generally is incomplete and not accurate. Such findings suggest that methods to improve the completeness and accuracy of medical history data could have clinical value. We address this issue with expert system software to enable automated history-taking by computers interacting directly with patients, i.e. computerized history-taking (CHT). Here we compare the completeness and accuracy of medical history data collected and recorded by physicians in electronic health records (EHR) with data collected by CHT for patients presenting to an emergency room with acute chest pain. Physician history-taking and CHT occurred at the same ED visit for all patients. CHT almost always preceded examination by a physician. Data fields analyzed were relevant to the differential diagnosis of chest pain and comprised information obtainable only by interviewing patients. Measures of data quality were completeness and consistency of negative and positive findings in EHR as compared with CHT datasets. Data significant for the differential of chest pain was missing randomly in all EHRs across all data items analyzed so that the dimensionality of EHR data was limited. CHT files were near complete for all data elements reviewed. Separate from the incompleteness of EHR data, there were frequent factual inconsistencies between EHR and CHT data across all data elements. EHR data did not contain representations of symptoms that were consistent with those reported by patients during CHT. Trial registration: This study is registered at https://www.clinicaltrials.gov (unique identifier: NCT03439449).


Assuntos
Dor no Peito/diagnóstico , Tomada de Decisão Clínica , Registros Eletrônicos de Saúde/normas , Anamnese/métodos , Adolescente , Adulto , Idoso , Dor no Peito/tratamento farmacológico , Conjuntos de Dados como Assunto , Tomada de Decisões Assistida por Computador , Serviços Médicos de Emergência/métodos , Sistemas Especialistas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nitroglicerina/uso terapêutico , Software , Fatores de Tempo , Vasodilatadores/uso terapêutico , Adulto Jovem
3.
Int J Surg ; 94: 106080, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34500081

RESUMO

BACKGROUND: To explore the feasibility and effectiveness of controlled low central venous pressure(CLCVP)induced by milrinone during hepatectomy, and its influence on perioperative hemodynamics, blood loss and patients' recovery, comparing with the traditional method by nitroglycerin. METHODS: 52 patients who underwent elective open hepatectomy were enrolled in the study and randomly divided into two groups: milrinone (M) group and nitroglycerin (NG) group. Milrinone was infused with the rate of 0.5 µg/kg/min in group M, while nitroglycerin was given 0.2-0.5 µg/kg/min in group NG to maintain CVP≤ 5 mmHg during liver resection. The demographic variables, data of the operative procedure and intraoperative hemodynamics were recorded. The postoperative recovery profiles and pre- and post-operative haematological markers of vital organs were also collected and compared. RESULTS: 1. The blood loss of group M, no matter during liver resection or in the whole procedure, was both less than that of group NG (P < 0.05), so did the hemoglobin detected by blood gas analysis (P < 0.05). Meanwhile, time of hepatectomy and hepatic hilum occlusion were shorter in group M (P < 0.05). 2. Compared with the NG group, cardiac index (CI) and stroke volume index (SVR) were higher in group M in the operation. The norepinephrine dosage necessary in the operation was of no difference in two groups (P > 0.05). 3. Drainage indwelling time and postoperative hospital stay of group M were shorter than that of group NG (P < 0.05). Most of the blood biomarkers increased on postoperative day (POD)-1, and returned to the preoperative level on POD-7 without inter-group difference (P > 0.05). Brain natriuretic peptide precursor (Pro-BNP) in group M was higher than NG group on POD-1 (P < 0.05), and the statistical difference disappeared on POD-7. CONCLUSION: Milrinone can effectively maintain a controlled low central venous pressure during hepatectomy. Compared with nitroglycerin, milrinone can reduce the amount of blood loss, with the benefit of better manifestation of hemodynamics and enhanced postoperative recovery.


Assuntos
Hepatectomia , Milrinona , Nitroglicerina , Pressão Venosa Central , Hemodinâmica , Humanos
4.
Int J Cardiol ; 344: 127-134, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34543690

RESUMO

BACKGROUND AND OBJECTIVE: Although recommended for the treatment of acute heart failure (AHF), the use of intravenous (IV) nitroglycerin (NTG) is supported by scarce and contradicting evidence. In the current analysis, we have assessed the impact of IV NTG administration by EMS or in emergency department (ED) on outcomes of AHF patients. METHODS: We analyze AHF patients included by 45 hospitals that were delivered to ED by EMS. Patients were grouped according to whether treatment with IV NTG was started by EMS before ED admission (preED-NTG), during the ED stay (ED-NTG) or were untreated with IV NTG (no-NTG, control group). In-hospital, 30-day and 365-day all-cause mortality, prolonged hospitalization (>7 days) and 90-day post-discharge combined adverse events (ED revisit, hospitalization or death) were compared in EMS-NTG and ED-NTG respect to control group. RESULTS: We included 8424 patients: preED-NTG = 292 (3.5%), ED-NTG = 1159 (13.8%) and no-NTG = 6973 (82.7%). preED-NTG group had the most severely decompensated cases of AHF (p < 0.001) but it had lower in-hospital (OR = 0.724, 95%CI = 0.459-1.114), 30-day (HR = 0.818, 0.576-1.163) and 365-day mortality (HR = 0.692, 0.551-0.869) and 90-day post-discharge events (HR = 0.795, 0.643-0.984) than control group. ED-NTG group had mortalities similar to control group (in-hospital: OR = 1.164, 0.936-1.448; 30-day: HR = 0.980, 0.819-1.174; 365-day: HR = 0.929, 0.830-1.039) but significantly decreased 90-day post-discharge events (HR = 0.870, 0.780-0.970). Prolonged hospitalization rate did not differ among groups. Five different analyses confirmed these findings. CONCLUSIONS: Early prehospital IV NTG administration was associated with lower mortality and post-discharge events, while IV NTG initiated in ED only improved post-discharge event rate. Further studies are needed to assess the role of early prehospital administration of IV NTG to patients with AHF.


Assuntos
Insuficiência Cardíaca , Nitroglicerina , Doença Aguda , Assistência ao Convalescente , Serviço Hospitalar de Emergência , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Alta do Paciente , Sistema de Registros
5.
Int J Mol Sci ; 22(16)2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34445170

RESUMO

Triple-negative breast cancer (TNBC) is a highly aggressive disease with invasive and metastasizing properties associated with a poor prognosis. The STAT3 signaling pathway has shown a pivotal role in cancer cell migration, invasion, metastasis and drug resistance of TNBC cells. IL-6 is a main upstream activator of the JAK2/STAT3 pathway. In the present study we examined the impact of the NO-donor glyceryl trinitrate (GTN) on the activation of the JAK2/STAT3 signaling pathway and subsequent migration, invasion and metastasis ability of TNBC cells through in vitro and in vivo experiments. We used a subtoxic dose of carboplatin and/or recombinant IL-6 to activate the JAK2/STAT3 signaling pathway and its functional outcomes. We found an inhibitory effect of GTN on the activation of the JAK2/STAT3 signaling, migration and invasion of TNBC cells. We discovered that GTN inhibits the activation of JAK2, the upstream activator of STAT3, and mediates the S-nitrosylation of JAK2. Finally, the effect of GTN (Nitronal) on lung metastasis was investigated to assess its antitumor activity in vivo.


Assuntos
Janus Quinase 2/metabolismo , Doadores de Óxido Nítrico/farmacologia , Nitroglicerina/farmacologia , Fator de Transcrição STAT3/metabolismo , Transdução de Sinais/efeitos dos fármacos , Neoplasias de Mama Triplo Negativas/tratamento farmacológico , Animais , Linhagem Celular Tumoral , Movimento Celular/efeitos dos fármacos , Feminino , Humanos , Camundongos , Camundongos Endogâmicos BALB C , Invasividade Neoplásica/prevenção & controle , Doadores de Óxido Nítrico/uso terapêutico , Nitroglicerina/uso terapêutico , Neoplasias de Mama Triplo Negativas/metabolismo
6.
ACS Chem Neurosci ; 12(18): 3303-3313, 2021 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-34455773

RESUMO

The present study intended to examine the effect of bergapten and possible mechanisms involved in the treatment of migraine-associated symptoms in the rat model. Five doses of nitroglycerin (10 mg/kg) were injected intraperitoneal to induce migraine headaches in rats with a one-day break between each dose. Treatment groups received nitroglycerin followed after 1 day by bergapten (50 or 100 mg/kg), saline (10 mL/kg), or sumatriptan (50 mg/kg) once daily for 10 days. Behavioral observations were analyzed 2 h after nitroglycerin injections and 1 h 40 min after treatment. The animals were sacrificed 24 h after the last treatment dose. Samples of trigeminal nucleus caudalis (TNC) and cerebral cortex were collected and analyzed for antioxidant activity and expression of inflammatory markers by immunohistochemistry and enzyme-linked immunosorbent assay. Our findings revealed that bergapten notably decreases headache by altering mechanical allodynia, thermal allodynia, light phobicity, and the number of head-scratching incidence in rats. In the cortex and TNC regions, antioxidant factors were restored, and lipid peroxidation was significantly reduced. Furthermore, bergapten decreased the expression of inflammatory markers, such as nuclear factor kappa B (NF-Kb) and tumor necrosis factor-alpha (TNF-α), as evidenced by immunohistochemistry and ELISA. These results suggest that bergapten exhibits headache-relieving activity, possibly mediated through antioxidant and anti-inflammatory pathways.


Assuntos
Transtornos de Enxaqueca , Nitroglicerina , 5-Metoxipsoraleno , Animais , Mediadores da Inflamação , Transtornos de Enxaqueca/tratamento farmacológico , Estresse Oxidativo , Ratos
7.
Biomed Res Int ; 2021: 6694150, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34395624

RESUMO

Background: Hemodynamic responses to laryngoscopy and endotracheal intubation are transient in most patients. However, in some patients with a history of heart disease, systemic hypertension, or cerebrovascular disease, these may lead to dangerous complications. This study is aimed at determining the effectiveness of intravenous nitroglycerin bolus doses in reducing hemodynamic responses to laryngoscopy and endotracheal intubation. Material and Method. In this double-blind randomized controlled trial, 78 patients aged 18 to 65 years were randomly divided into three groups: 1 µg/kg dose of nitroglycerin (first group), 2 µg/kg dose of nitroglycerin (second group), and normal saline or placebo (third group). 26 samples were allocated for each group. Patients' hemodynamic responses to laryngoscopy and endotracheal intubation were measured at different times. Data were analyzed using SPSS V 16. Results: Patients in the three study groups were similar in terms of age, sex, and weight. There was no significant difference between the mean saturation of peripheral oxygen (SPO2) and the mean heart rate between the three groups before endotracheal intubation and 1 to 10 minutes after intubation (P > 0.05). The difference of mean arterial blood pressure between study groups was only significant in the first and fifth minutes after intubation. Mean systolic and diastolic blood pressure in the first, third, and fifth minutes after intubation was significantly lower in the intervention groups than the control group (P < 0.05). However, no significant difference was observed between the intervention groups. The frequency of systolic blood pressure decrease was significantly different in the first and fifth minutes after intubation in the three study groups (P < 0.05). Conclusion: Bolus doses of 1 and 2 µg/kg nitroglycerin in noncardiac elective surgery prevents the increase of mean systolic, diastolic, and arterial blood pressure but has no significant effect on heart rate after intubation.


Assuntos
Hemodinâmica/efeitos dos fármacos , Intubação Intratraqueal/efeitos adversos , Laringoscopia/efeitos adversos , Nitroglicerina/administração & dosagem , Adulto , Pressão Sanguínea/efeitos dos fármacos , Método Duplo-Cego , Esquema de Medicação , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Nitroglicerina/farmacologia , Resultado do Tratamento , Adulto Jovem
8.
Undersea Hyperb Med ; 48(3): 255-261, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34390630

RESUMO

Introduction: Foreign body emboli can lead to acute arterial insufficiency. We present a case report of upper extremity arterial insufficiency in an intravenous (IV) drug user secondary to intra-arterial injection of crushed tablet particles successfully treated with hyperbaric oxygen (HBO2) therapy. Case: A 37-year-old right-hand-dominant male developed pain and swelling of the left hand after attempting to inject crushed hydromorphone tablets into his venous circulation. Angiography revealed incomplete distal filling of the proper digital arteries, princeps pollicis, and radialis indicis branches of the left hand. The patient was treated with HBO2 for acute arterial insufficiency, secondary to these findings. Fluorescence angiography was performed prior to, during and after completion of HBO2, which showed improved perfusion of the hand upon completion of serial imaging. The patient underwent subsequent partial amputation of the left second digit and removal of the thenar and third finger pads. Discussion: Much of the literature on treatment of arterial insufficiency with HBO2 are in relation to chronic problem wounds. However, there is limited data on adjunctive treatment with HBO2 for foreign body embolism. Fluorescence angiography and clinical exam were used to track tissue perfusion and progression throughout course of therapy with HBO2. Conclusion: Acute arterial insufficiency induced by foreign body embolism was successfully treated with HBO2 and provided increased tissue salvage of the patient's hand. The use of fluorescence angiography as a secondary measure of perfusion can provide additional insight regarding qualitative tissue oxygenation and may be a viable tool to track patient progress during HBO2 treatment.


Assuntos
Angiofluoresceinografia , Mãos/irrigação sanguínea , Hidromorfona/efeitos adversos , Oxigenação Hiperbárica/métodos , Entorpecentes/efeitos adversos , Doença Arterial Periférica/terapia , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Lateralidade Funcional , Humanos , Hidromorfona/administração & dosagem , Masculino , Entorpecentes/administração & dosagem , Nitroglicerina/uso terapêutico , Doença Arterial Periférica/induzido quimicamente , Doença Arterial Periférica/diagnóstico por imagem , Vasodilatadores/uso terapêutico , Verapamil/uso terapêutico
10.
Am J Physiol Regul Integr Comp Physiol ; 321(4): R525-R536, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34378422

RESUMO

The effects of nitroglycerin (glyceryl trinitrate, GTN) on baroreflex sensitivity (BRS) are incompletely understood. Moreover, there are no reports evaluating the acute responses in both the sympathetic BRS (SBRS) and the cardiovagal BRS (CBRS) to the administration of sublingual GTN. We hypothesized that sublingual GTN modulates both CBRS and SBRS. In 10 healthy subjects, beat-to-beat heart rate (HR), blood pressure (BP), and muscle sympathetic nerve activity (MSNA) were recorded before and for 10 min after sublingual administration of GTN 0.4 mg. SBRS was evaluated from the relationship between spontaneous variations in diastolic BP and MSNA. CBRS was assessed with the sequence technique. These variables were assessed during baseline, during 3rd-6th min (post A), and 7th-10th min (post B) after GTN administration. Two min after GTN administration, MSNA increased significantly and remained significantly elevated during recording. Compared with baseline, CBRS decreased significantly (post A: 12.9 ± 1.6 to 7.1 ± 1.0 ms/mmHg, P < 0.05), whereas SBRS increased significantly (post A: 0.8 ± 0.2 to 1.5 ± 0.2 units·beat-1·mmHg-1, P < 0.05) with an upward shift of the operating point. There were no differences in these variables between posts A and B. A clinical dose of GTN increased MSNA rapidly through effects on both CBRS and SBRS. These effects should be kept in mind when nitrates are used to clinically treat chest pain and acute coronary syndromes and used as vasodilators in experimental settings.


Assuntos
Barorreflexo/efeitos dos fármacos , Coração/inervação , Músculo Esquelético/inervação , Nitroglicerina/administração & dosagem , Sistema Nervoso Simpático/efeitos dos fármacos , Nervo Vago/efeitos dos fármacos , Vasodilatadores/administração & dosagem , Administração Sublingual , Pressão Sanguínea/efeitos dos fármacos , Feminino , Voluntários Saudáveis , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Sistema Nervoso Simpático/fisiologia , Nervo Vago/fisiologia
11.
J Headache Pain ; 22(1): 86, 2021 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-34325647

RESUMO

BACKGROUND: Central sensitization is considered a critical pathogenic mechanism of chronic migraine (CM). Activation of microglia in the trigeminal nucleus caudalis (TNC) contributes to this progression. Microglial glucagon-like peptide-1 receptor (GLP-1R) activation can alleviate pain; however, whether it is involved in the mechanism of CM has not been determined. Thus, this study aims to investigate the precise role of GLP-1R in the central sensitization of CM. METHODS: Repeated nitroglycerin injection-treated mice were used as a CM animal model in the experiment. To identify the distribution and cell localization of GLP-1R in the TNC, we performed immunofluorescence staining. Changes in the expression of GLP-1R, Iba-1, PI3K and p-Akt in the TNC were examined by western blotting. To confirm the effect of GLP-1R and PI3K/Akt in CM, a GLP-1R selective agonist (liraglutide) and antagonist (exendin(9-39)) and a PI3K selective antagonist (LY294002) were administered. Mechanical hypersensitivity was measured through von Frey filaments. To investigate the role of GLP-1R in central sensitization, calcitonin gene-related peptide (CGRP) and c-fos were determined using western blotting and immunofluorescence. To determine the changes in microglial activation, IL-1ß and TNF-α were examined by western blotting, and the number and morphology of microglia were measured by immunofluorescence. We also confirmed the effect of GLP-1R on microglial activation in lipopolysaccharide-treated BV-2 microglia. RESULTS: The protein expression of GLP-1R was increased in the TNC after nitroglycerin injection. GLP-1R was colocalized with microglia and astrocytes in the TNC and was fully expressed in BV-2 microglia. The GLP-1R agonist liraglutide alleviated basal allodynia and suppressed the upregulation of CGRP, c-fos and PI3K/p-Akt in the TNC. Similarly, the PI3K inhibitor LY294002 prevented nitroglycerin-induced hyperalgesia. In addition, activating GLP-1R reduced Iba-1, IL-1ß and TNF-α release and inhibited TNC microglial number and morphological changes (process retraction) following nitroglycerin administration. In vitro, the protein levels of IL-1ß and TNF-α in lipopolysaccharide-stimulated BV-2 microglia were also decreased by liraglutide. CONCLUSIONS: These findings suggest that microglial GLP-1R activation in the TNC may suppress the central sensitization of CM by regulating TNC microglial activation via the PI3K/Akt pathway.


Assuntos
Sensibilização do Sistema Nervoso Central , Transtornos de Enxaqueca , Animais , Receptor do Peptídeo Semelhante ao Glucagon 1 , Camundongos , Microglia , Transtornos de Enxaqueca/induzido quimicamente , Transtornos de Enxaqueca/tratamento farmacológico , Nitroglicerina/farmacologia , Fosfatidilinositol 3-Quinases , Núcleos do Trigêmeo
12.
Eur J Neurosci ; 54(3): 5189-5202, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34197660

RESUMO

The hypothalamus has been suggested to be important in the initiation cascade of migraine attacks based on clinical and biochemical observations. Previous imaging studies could not disentangle the changes due to the attack and those due to the trigger compound. With a novel approach, we assessed hypothalamic neuronal activity in early premonitory phases of glyceryl-trinitrate (GTN)-induced and spontaneous migraine attacks. We measured the hypothalamic blood oxygen level-dependent (BOLD) response to oral glucose ingestion with 3T-functional magnetic resonance imaging (MRI) in 27 women, 16 with migraine without aura and 11 controls group matched for age and body mass index (BMI), on 1 day without prior GTN administration and on a second day after GTN administration (to coincide with the premonitory phase of an induced attack). Interestingly, subgroups of patients with and without GTN-triggered attacks could be compared. Additionally, five migraineurs were investigated in a spontaneous premonitory phase. Linear mixed models were used to study between- and within-group effects. Without prior GTN infusion, the BOLD response to glucose was similar in migraine participants and controls (P = .41). After prior GTN infusion, recovery occurred steeper and faster in migraineurs (versus Day 1; P < .0001) and in those who developed an attack versus those who did not (P < .0001). Prior GTN infusion did not alter the glucose-induced response in controls (versus baseline; P = .71). Just before spontaneous attacks, the BOLD-response recovery was also faster (P < .0001). In this study, we found new and direct evidence of altered hypothalamic neuronal function in the immediate preclinical phase of both GTN-provoked and spontaneous migraine attacks.


Assuntos
Transtornos de Enxaqueca , Nitroglicerina , Cognição , Feminino , Humanos , Hipotálamo , Imageamento por Ressonância Magnética , Transtornos de Enxaqueca/induzido quimicamente , Transtornos de Enxaqueca/diagnóstico por imagem , Nitroglicerina/toxicidade
13.
J Invasive Cardiol ; 33(7): E584, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34224391

RESUMO

A recent guideline has recommended the radial artery as the access site for coronary catheterization due to lower risk of bleeding and vascular complications. However, the transradial approach is not necessarily easy for interventionalists due to the smaller vessel diameter and more frequent occurrence of vasospasm induced by the procedure. By using the measurement in ultrasound, a previous study demonstrated that subcutaneous nitroglycerin injection at the radial artery puncture site dilated the radial artery, and that a patch was also easier and less invasive. The current case suggests the applicability of a nitroglycerin transdermal patch to prevent vasospasm via local transdermal absorption into the arterial wall; its use may lead to a higher success rate for the transradial approach, especially in patients who had experienced radial artery vasospasm.


Assuntos
Nitroglicerina , Artéria Radial , Cateterismo Cardíaco/efeitos adversos , Humanos , Espasmo/etiologia , Espasmo/prevenção & controle , Adesivo Transdérmico , Vasodilatadores/uso terapêutico
14.
Med Gas Res ; 11(4): 131-137, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34213494

RESUMO

In this blinded clinical trial, we attempted to compare the efficacy and safety of administering tranexamic acid, dexmedetomidine and nitroglycerin in preventing intraoperative bleeding and improving the quality of the surgical field during septorhinoplasty under general anesthesia. A total of 105 patients scheduled for septorhinoplasty were enrolled and randomly assigned into three groups based on the balanced-block randomization method. First group received 1 µg/kg intravenous injection dexmedetomidine, second group received 10 mg/kg intravenous injection tranexamic acid and third group received 0.5 µg/kg nitroglycerin, intravenously. The study sample was composed of 105 participants with the total mean age of 25.85 ± 6.52 years, and 59.05% of participants were female and the mean of body mass index was 24.34 ± 2.57 kg/m2. The results showed that there was no statistically significant difference in terms of arterial oxygen saturation, mean arterial pressure, heart rate, bleeding rate, duration of surgery, and surgeon satisfaction among the three groups; however, there was a significant difference in the extubation time, recovery time and the dose of administered propofol among the three groups. Dexmedetomidine reduced the dose of administered propofol while increasing the extubation time and recovery time. In the tranexamic acid group compared with the other two groups, the recovery time was shorter. However, all the three drugs could reduce intraoperative bleeding and lead to surgeon satisfaction. It can be concluded that all these three drugs can be utilized to control bleeding and improve the quality of the surgical field but the ultimate decision lies with the anesthesiologist's judgment and the conditions of the patient. The study protocol was registered in the Iranian Registry of Clinical Trials (registration No. IRCT20141209020258N121) on September 24, 2019 and it was ethically approved by the Ethical Committee of Arak University of Medical Sciences (approval No. IR.ARAKMU.REC.1397.355) on February 24, 2019.


Assuntos
Dexmedetomidina , Ácido Tranexâmico , Adulto , Anestesia Geral , Método Duplo-Cego , Feminino , Humanos , Irã (Geográfico) , Nitroglicerina , Adulto Jovem
15.
J Emerg Med ; 61(3): 271-277, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34215472

RESUMO

BACKGROUND: Sympathetic crashing acute pulmonary edema (SCAPE) is a severe form of hypertensive acute heart failure with a dramatic presentation. Rapid identification and management in the emergency department (ED) is key to saving these patients and preventing morbidity associated with endotracheal intubation and intensive care treatment. Use of high-dose nitroglycerin (NTG) and noninvasive ventilation (NIV) has been advocated in management of such patients. OBJECTIVE: To study the feasibility and safety of high-dose NTG combined with NIV in SCAPE. METHODS: This was a prospective observational pilot study done in the ED of a tertiary care hospital. All patients were treated with high-dose NTG and NIV. The primary objective was to study the feasibility and safety of the SCAPE management protocol in terms of the outcome of the patient. Resolution of symptoms in 6 h and need for intubation were recorded as endpoints. Any complications associated with high-dose NTG were also recorded. RESULTS: A total of 25 patients were recruited. The mean bolus dose of NTG given was 872 µg, and mean cumulative dose, 35 mg. There was no incidence of hypotension after the bolus dose of nitroglycerin. Eleven patients had resolution of symptoms at 3 h of therapy. Twenty-four patients were discharged from the ED itself after a brief period of observation, and one patient was intubated and shifted to the intensive care unit. CONCLUSION: Use of our specific SCAPE treatment algorithm, which included high-dose NTG and NIV, was safe and provided rapid resolution of symptoms.


Assuntos
Insuficiência Cardíaca , Ventilação não Invasiva , Edema Pulmonar , Humanos , Nitroglicerina/uso terapêutico , Projetos Piloto , Estudos Prospectivos , Edema Pulmonar/tratamento farmacológico
16.
Cardiol Young ; 31(9): 1381-1385, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34082850

RESUMO

OBJECTIVES: Acute pulmonary hypertension and pulmonary hypertensive crisis may result in adverse clinical outcomes if unsuccessfully treated. Inhaled nitric oxide has long been considered as the standard pharmacotherapy for acute pulmonary hypertension, but lack of feasibility in some settings and evidences challenging its benefits lead to the use of alternative treatment, amongst which is nitroglycerin inhalation. The purpose of this review article is to discuss available data on the use of nitroglycerin inhalation for acute treatment of pulmonary hypertension in children with CHD and its potential benefit in post-operative setting. DATA SOURCES: Literatures included in this review were acquired by searching in PubMed online database. Keywords used were "Pulmonary Hypertension", "Congenital heart defects", "Pediatrics", "Inhaled nitroglycerin", and its synonyms. STUDY SELECTION: Title and abstract were screened to select relevant literatures including the three paediatric clinical trials on nitroglycerin inhalation. Critical appraisal of the clinical trials was then done using the University of Oxford Centre of Evidence-Based Medicine Critical Appraisal Tools. CONCLUSIONS: Paediatric studies showed the benefit of nitroglycerin inhalation in uncorrected cases of CHD during catheterisation procedures. Until recently, there have been no studies conducted in paediatric post-operative CHD cases. Further study is required to provide evidence for inhaled nitroglycerin use in this setting including the appropriate dosing and potential side effects with repeated administration.


Assuntos
Cardiopatias Congênitas , Hipertensão Pulmonar , Hipertensão Arterial Pulmonar , Administração por Inalação , Criança , Cardiopatias Congênitas/complicações , Humanos , Hipertensão Pulmonar/tratamento farmacológico , Hipertensão Pulmonar/etiologia , Nitroglicerina/uso terapêutico
17.
Clin Cardiol ; 44(7): 932-937, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34076282

RESUMO

BACKGROUND: Rapid diagnosis of heart failure (HF) in acutely dyspneic patients can be challenging for emergency department (ED) physicians. HYPOTHESIS: Cardiac output (CO) change with sublingual nitroglycerin (NTG) could be helpful in the diagnosis of HF in patients with acute undifferentiated dyspnea. MATERIALS AND METHODS: A prospective study of patients >18 years admitted to the ED for acute dyspnea. Using thoracic bioimpedance, we measured CO change at baseline and after sublingual administration of 0.6 mg of NTG. HF was defined on the basis of clinical examination, pro-brain natriuretic peptide levels, and echocardiographic findings. Diagnostic performance of delta CO was calculated by sensitivity, specificity, likelihood ratio and receiver operating characteristic (ROC) curve. RESULTS: This study included 184 patients with mean age of 64 years. Baseline CO was comparable between the HF group and the non-HF group. At its best cutoff (29%), delta CO showed good accuracy in the diagnosis of HF with a sensitivity, specificity, positive and negative likelihood ratios of 80%, 44%, 57%, and 66% respectively. Area under ROC curve was 0.701 [95% CI 0.636-0.760]. The decrease of CO with sublingual NTG was significantly higher in patients with HFpEF compared with those with HFrEF. Multivariate analysis, showed that delta CO was an independent factor associated with HF diagnosis [OR 0.19 (95% CI 0.11-0.29); p < .001]. CONCLUSIONS: Our study showed that CO change with sublingual nitroglycerin is a simple tool that may be helpful for the diagnosis of HF in ED patients with undifferentiated dyspnea.


Assuntos
Insuficiência Cardíaca , Doença Aguda , Dispneia/diagnóstico , Dispneia/etiologia , Serviço Hospitalar de Emergência , Insuficiência Cardíaca/diagnóstico , Humanos , Peptídeo Natriurético Encefálico , Nitroglicerina , Estudos Prospectivos , Sensibilidade e Especificidade , Volume Sistólico
18.
Pain ; 162(10): 2499-2511, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34108435

RESUMO

ABSTRACT: Migraine is one of the most common neurological disorders characterized by recurrent attacks of typically throbbing and unilateral headaches, affecting up to 20% of the population worldwide. Despite the high prevalence and severity of this primary headache disorder, it remains to be a challenge to fully understand and treat migraine headaches. By characterizing and validating a mouse migraine model, this study aimed to investigate the functional contribution of protein kinase C (PKC) isoforms in migraine. In this study, we identified the presence of migraine-like ongoing pain in mice after chronic intermittent treatment with nitroglycerin (NTG). The peptide antagonist of calcitonin gene-related peptide α-CGRP (8-37), but not topiramate nor sumatriptan, effectively blocked ongoing pain and elicited pain relief-induced conditioned place preference in NTG-treated mice. Prominent activation of PKCδ was observed in chronic NTG-treated mice. Functional inhibition of PKCδ significantly attenuated ongoing spontaneous pain in chronic NTG-treated mice. Furthermore, we recapitulated the NTG-triggered migraine behavior in wild-type mice, but not in PKCδ-null mice. In response to repeated administration of NTG, ongoing spontaneous pain was not developed in mice lacking the specific PKC isoform. This study identified the presence of ongoing pain in mice treated with NTG, a known human migraine trigger that closely resembles the common manifestation of spontaneous migraine attacks in humans. These findings demonstrated a critical regulatory role of PKCδ in migraine pathophysiology, which may offer new pharmacological targets for antimigraine treatment.


Assuntos
Transtornos de Enxaqueca , Nitroglicerina , Proteína Quinase C-delta , Animais , Modelos Animais de Doenças , Cefaleia , Hiperalgesia , Camundongos , Transtornos de Enxaqueca/induzido quimicamente , Transtornos de Enxaqueca/genética , Proteína Quinase C-delta/genética
19.
Medicina (Kaunas) ; 57(5)2021 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-34065827

RESUMO

The PROPESS, a controlled-release dinoprostone vaginal delivery system, is a pharmacological cervical ripening intervention and promotes cervical change causing uterine contraction. During insertion of the PROPESS, uterine hyperstimulation could occur and result in fetal heart rate (FHR) abnormality. We report a case of uterine hyperstimulation accompanied with FHR abnormality caused by the PROPESS in a pregnant woman. Postural change, oxygenation, fluid infusion, and the immediate PROPESS removal were ineffective to address the adverse event, so we administered nitroglycerin for acute uterine relaxation. The nitroglycerin resulted in uterine relaxation, and the FHR abnormality was resolved immediately, thereby preventing an emergency cesarean section. Therefore, nitroglycerin could be considered an effective option for uterine hyperstimulation accompanied with FHR abnormality caused by the PROPESS.


Assuntos
Dinoprostona , Ocitócicos , Cesárea , Preparações de Ação Retardada , Feminino , Frequência Cardíaca Fetal , Humanos , Trabalho de Parto Induzido , Nitroglicerina/uso terapêutico , Ocitócicos/uso terapêutico , Gravidez
20.
Medicine (Baltimore) ; 100(21): e26038, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032727

RESUMO

ABSTRACT: Most cases of primary microvascular angina pectoris (PMVA) are diagnosed clinically, but the etiology and pathological mechanisms are unknown. The effect of routine clinical medications is minimal, and PMVA can progress to serious cardiovascular events. To improve the diagnosis and effective treatment of this disease, this study was designed to diagnose PMVA via cardiovascular magnetic resonance (CMR) and the coronary angiography thrombolysis in myocardial infarction (TIMI) blood flow grade, as well as to analyze vascular endothelial function to elucidate the pathogenesis of PMVA and compare the effects of routine clinical medications.The present randomized controlled trial including a parallel control group will be conducted on 63 PMVA patients in our cardiovascular department. The patients will be selected and randomly divided into the control, diltiazem, and nicorandil groups. The control group will be administered routine drug treatments (aspirin, atorvastatin, betaloc ZOK, perindopril, and isosorbidemononitrate sustained-release tablets). The diltiazem group will be additionally treated with 90 mg qd diltiazem sustained-release capsules. The nicorandil group was additionally given 5 mg tid nicorandil tablets. Coronary angiography will be performed before treatment, the severity and frequency of chest pain will be evaluated before and after 9 months of treatment, and homocysteine and von Willebrand factor levels will be measured. Electrocardiography, echocardiography, dynamic electrocardiography, a treadmill exercise test, and CMR will be performed. Sex, age, body mass index, complications, smoking, and family history will also be recorded. The SPSS19.0 statistical software package will be used to analyze the data. The measurements will be expressed as the mean ±â€Šstandard deviation. Measurement data will be compared between the groups using Student's t-test. A relative number description will be used for the counting data, and the chi-squaretest will be used to compare the groups. A multivariate logistic regression analysis will be performed A P-value < .05 will be considered significant.The direct indices (CMR and coronary angiographic TIMI blood flow grade) may improve after adding diltiazem or nicorandil during routine drug treatments (such as aspirin, statins, and nitrates) in PMVA patients, and indirect indices (homocysteine and von Willebrand factor levels) may be reduced. TRIAL REGISTRATION: Chinese Clinical Trial Registry (http://www.chictr.org.cn/showprojen.aspx?proj=41894), No. CHiCTR1900025319, Registered on August 23, 2019; pre initiation.


Assuntos
Sistema Cardiovascular/diagnóstico por imagem , Angiografia Coronária , Imageamento por Ressonância Magnética , Angina Microvascular/diagnóstico , Vasodilatadores/administração & dosagem , Adolescente , Adulto , Idoso , Aspirina/administração & dosagem , Sistema Cardiovascular/efeitos dos fármacos , Diltiazem/administração & dosagem , Quimioterapia Combinada/métodos , Eletrocardiografia , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Masculino , Angina Microvascular/tratamento farmacológico , Pessoa de Meia-Idade , Nicorandil/administração & dosagem , Nitroglicerina/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Adulto Jovem
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