Consensus must be found on intravenous fluid therapy management in trauma patients

Introduction: Trauma is an important cause of death among young people and 30-40% of this mortality rate is due to hypovolemic shock, intensified by trauma's lethal triad: Hypothermia, Acidosis, and Coagulopathy. Nurses are responsible for managing fluid therapy administration in trauma victims. The purpose of this study is to analyse the reasons why intravenous fluid therapy is recommended for trauma patients' hemodynamic stabilization. Methods: This narrative literature review included published and unpublished studies in English, Spanish or Portuguese between 1994 and January 2019. The search results were analyzed by two independent reviewers. Inclusion criteria encompasses quantitative studies involving trauma victims aged over 18 who underwent fluid therapy in a prehospital assessment context. Results&Discussion: 11 quantitative studies were included. 9 involved the use of fluid therapy for hypotension treatment and 2 of the studies analyzed involved the use of warmed fluid therapy for hypothermia treatment. The analysis performed reveals that the administration of aggressive fluid therapy seems to be responsible for the worsening of the lethal triad. In the presence of traumatic brain injury, permissive hypotension is not allowed due to the negative impact on cerebral perfusion pressure. Used as warming measure, warmed fluid therapy does not seem to have a significant impact on body temperature. Conclusions: There is no consensus regarding the administration of fluid therapy to trauma patients. This conclusion clearly supports the need to develop more randomized controlled trials in order to understand the effectiveness of such measure when it comes to control hypovolemia and hypothermia.info:eu-repo/semantics/publishedVersio

Monitoring Antibiotic Comsumption in the Surgery and Orthopaedics

A monitorização do consumo de antimicrobianos é um instrumento de interesse indiscutível e tem merecido uma atenção particular nos últimos anos, devido às crescentes preocupações com a emergência de estirpes microbianas multi-resistentes. Os objectivos do presente estudo consistiram, por um lado, na monitorização do consumo e na avaliação do impacto económico da prescrição hospitalar de antimicrobianos, em serviços de cirurgia e ortopedia. Por outro lado, pretendeu-se estudar e a relação indicação-prescrição terapêutica e profilática. Tendo presentes estes objectivos realizou-se um estudo-piloto longitudinal, com recolha de dados durante o mês de Maio de 2004, em seis Hospitais SA, incidindo numa amostra total de 1.122 doentes internados. Verificámos uma taxa de incidência de prescrição de 76,9%, com dispensa de 1.154 antimicrobianos, dos quais 71,2% se destinaram, em média, à profilaxia da infecção pós-cirúrgica, atestando a adesão geral à prática da profilaxia da infecção no local cirúrgico. O custo médio da antibioterapia foi mais elevado nos casos de “suspeita de infecção” (€9,09) ou “infecção declarada” (€8,74) e mais baixo quando utilizados para “profilaxia” (€5,67), facto relacionado com a menor duração média dos episódios de profilaxia. Os regimes de profilaxia utilizados apresentaram variações consideráveis entre os diferentes hospitais no que respeita ao tipo de antibiótico utilizado e uma duração média de 2,61 dias, com cerca de metade dos episódios de profilaxia prolongando-se por mais de 24 horas, sugerindo uma implementação insuficiente das actuais recomendações quanto ao tipo de fármaco a utilizar para esta prática, o que aponta para o necessidade duma avaliação da existência nas unidades hospitalares, de recomendações claras para a profilaxia da infecção do local cirúrgico, bem como da adesão dos clínicos a estas

Bioactivity studies and chemical profile of the antidiabetic plant Genista tenera

Aim of the study: Genista tenera is a plant endemic to the island of Madeira and is used in folk medicine to control diabetes. In the present work we evaluate the antihyperglycaemic activity of its n-butanol extract and determine its chromatographic profile. In addition, this extract, the ethyl acetate and diethyl ether plant extracts were studied in order to assess the plant antioxidant and acetylcholinesterase inhibitory activities, as well as its cyto- and genotoxicities. Materials and methods: HPLC-DAD-ESI-MS was used to analyze the flavonoid profile of the n-butanol extract. The antihyperglycaemic activity of this extract was performed over streptozotocin induced diabetic Wistar rats (200mg/kg, bw/day), for 15 days. Antioxidant activity (DPPH assay) and acetylcholinesterase inhibitory effect (Ellman method) were also performed. Acute cytotoxicity and genotoxicity were assessed by proliferative index quantification and the short-term chromosomal aberration technique, after exposure of lymphocytes to the extracts. Results and conclusions: The n-butanol extract, where 21 monoglycosyl and 12 diglycosyl flavonoids were detected, significantly lowered blood glucose levels, bringing them to normal values after 15 days of treatment. The best radical scavenging activity was observed for the ethyl acetate extract (48.7% at 139.1μg/mL), which was also the most effective one at the minimal concentration tested. The highest acetylcholinesterase inhibitory activity (77.0% at 70. 0μg/mL) was also obtained with the ethyl acetate extract. In vitro toxicity studies showed no evidence for acute cytotoxicity or genotoxicity. This is the first report on antidiabetic activity of genus Genista.MCES, FCT, British Council; BBSRC and Merck, Sharp & Dohm

Phenylephrine induces endogenous noradrenaline release in the rat vas deferens through nitric oxide synthase pathway

We have previously observed that in the rat vas deferens nitric oxide synthase pathway potentiated phenylephrine-induced contractility raising the possibility of a facilitatory role on neurotransmission by nitric oxide. To confirm this hypothesis we studied the effect of phenylephrine on the concentration response curves obtained in preparations from reserpine-treated rats in the absence and presence of the nitric oxide synthase inhibitor N-G-monomethyl-L-arginine (L-NMMA). The endogenous noradrenaline released by normal preparations (without reserpine) was measured in the perfusion fluid of preparations stimulated with phenylephrine, in the absence and presence of L-NMMA, L-NMMA + the nitric oxide donor 3-morpholinosydnonimine hydrochloride (SIN-1), the alpha(1)-adrenoceptor antagonist prazosin and the blocker of noradrenaline carrier desipramine. The phenylephrine-induced noradrenaline release in a calcium-free medium was also measured. L-NMMA decreased the E-max of phenylephrine concentration response curves obtained in preparations from normal (reserpine-untreated) but not from reserpine-treated rats. In the perfusion fluid of preparations incubated with phenylephrine, a concentration-dependent increase of noradrenaline was observed which was reversed by L-NMMA and restored when SIN-1 was added together with the nitric oxide synthase inhibitor. The concentration-dependent phenylephrine-induced noradrenaline increase was not modified by desipramine but was abolished by 10 muM prazosin. In calcium-free medium, phenylephrine failed to increase the noradrenaline concentration. These results suggest that in the rat vas deferens, nitric oxide pathway potentiates the phenylephrine-induced contractility through a mechanism which involves calcium-dependent release of endogenous noradrenaline and seems to depend, at least partially on the activation of alpha(1)-adrenoceptors

Hemin reduces inflammation associated with TNBS-induced colitis

Vanessa Mateus,1,2 João Rocha,2 Hélder Mota-Filipe,2 Bruno Sepodes,2 Rui Pinto2,3 1H&TRC – Health and Technology Research Center, ESTeSL – Lisbon School of Health Technology, Instituto Politécnico de Lisboa, Lisbon, Portugal; 2iMed.ULisboa, Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal; 3Dr. Joaquim Chaves, Laboratory of Clinical Analysis, Joaquim Chaves Saúde, Lisbon, Portugal Purpose: Hemin is a heme-oxygenase inducer, which can confer anti-inflammatory, cytoprotective, and antiapoptotic effects. These properties are beneficial therapeutical effects to inflammatory bowel disease (IBD). IBD is a worldwide health problem characterized by chronic inflammation of intestinal epithelium, which promotes intestinal and extraintestinal symptomatology. Current treatment only induces and maintains the patient in remission and results in many side effects. The research of other pharmacologic approaches is crucial to the treatment of IBD. The aim of this study is to evaluate the effect of hemin in the 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced colitis model.Materials and methods: Male CD-1 mice with TNBS-induced colitis were treated with a daily dose of hemin 5 mg/kg body weight/day and 10 mg/kg body weight/day intraperitoneal, during 4 days. The evaluated parameters were fecal hemoglobin, alkaline phosphatase (ALP), myeloperoxidase, tumor necrosis factor-α, interleukin (IL)-1β, IL-10, histopathologic analysis, urea, creatinine, and alanine aminotransferase.Results: The hemin-treated mice presented a decrease in fecal hemoglobin, ALP, and proinflammatory cytokine concentrations compared to the TNBS group. Histopathology analysis confirmed the decrease in lesion extension produced by hemin.Conclusion: These findings suggest that hemin treatment reduces hemorrhagic focus, intestinal damage, tissue inflammation, and lesion extension associated with experimental colitis. Keywords: inflammatory bowel disease, experimental colitis, anti-inflammatory effect, heme-oxygenase induce