Tales Rubens de Nadai

Does rosmarinic acid underestimate as an experimental cardiovascular drug

PURPOSE The rationale of the present review is to analize the activity of Rosmarinus officinalis in the the cardiovascular system METHODS A MEDLINE database search (from January 1970 to December 2011) using only rosmarinic acid as searched term. RESULTS The references search revealed 509 references about rosmarinic acid in 40 years (the first reference is from 1970). There is a powerful prevalence of antioxidant and cancer studies. Other diseases are few cited, as inflammation, brain (Alzheimer and Parkinson disease) and, memory; allergy; diabetes; atherosclerosis, and; hypertension. It is necessary to consider the complete absence of studies on coronary artery disease, myocardial ischemia, heart failure or ischemia/reperfusion injury. CONCLUSION Rosmarinic acid is underestimated as an experimental cardiovascular drug and deserves more attention.

Dorsal raphe nucleus and locus coeruleus neural networks and the elaboration of the sweet-substance-induced antinociception.

In order to investigate the effects of monoaminergic neurons of the dorsal raphe nucleus (DRN) and locus coeruleus (LC) on the elaboration and control of sweet-substance-induced antinociception, male albino Wistar rats weighing 180-200 g received sucrose solution (250 g/L) for 7-14 days as their only source of liquid. After the chronic consumption of sucrose solution, each animal was pretreated with unilateral microinjection of ibotenic acid (1.0 microg/0.2 microL) in the DRN or in the LC. The tail withdrawal latencies of the rats in the tail-flick test were measured immediately before and 7 days after this treatment. The neurochemical lesion of locus coeruleus, but not of DRN neural networks with ibotenic acid, after the chronic intake of sweetened solution, decreased the sweet-substance-induced antinociception. These results indicate the involvement of noradrenaline-containing neurons of the LC in the sucrose-induced antinociception. We also consider the possibility of DRN serotonergic neurons exerting some inhibitory effect on the LC neural networks involved with the elaboration of the sweet-substance-induced antinociception.

Confounding Variables and the Performance of Triggers in Detecting Unreported Adverse Drug Reactions

PURPOSE This study explored the performance of trigger in detecting adverse drug reactions (ADRs), the confounding variables impairing the causal association of the ADRs, and the underreporting rate by hospital health professionals. METHODS A 6-month cross-sectional study was conducted in a public general hospital. Data collection was conducted in 2 stages: (1) screening of patient hospitalizations to identify suspected ADRs with 9 triggers developed by the Institute of Healthcare Improvement; and (2) chart review to perform the causality assessment of the suspected ADRs identified, to describe the confounding variables associated with detection of suspected ADRs that were not drug induced, and to analyze the positive predictive value of triggers in recognizing ADRs. To estimate the underreporting rate, ADRs detected by using the tool were compared with ADRs reported by health professionals during the same period. FINDINGS During the study period, 3318 hospitalizations were analyzed. A total of 837 suspected ADRs were identified. However, after causality assessment, 356 were definite ADRs. Confounding variables associated with the detection-suspected ADRs were related to the clinical conditions of inpatients. The use of triggers contributed to increased ADR detection by 10.5%. The performance ranged from 0.00 to 0.75, with an overall positive predictive value of 0.43. Six ADRs were spontaneously reported, of which just 1 was also detected by using the trigger tool. Only 1 of 356 potential ADRs was reported by health professionals. IMPLICATIONS Findings show that the use of triggers contributes to detecting ADRs underreported by health professionals. However, confounding variables impaired the performance of the tool because they underestimated the causal association. Furthermore, both methods are complementary to early recognition of drug-induced harm and should be applied together in health institutions to contribute to policies of risk management, drug safety, and optimization of pharmacotherapy.

Metabolic Acidosis Treatment as Part of a Strategy to Curb Inflammation

Abnormalities in systemic acid-base balance may induce significant changes in the immune response, and they may play a significant role in the development or maintenance of immune dysfunction. Different forms of acidosis (metabolic and respiratory) and even different types of metabolic acidosis (hyperchloremic and lactic) may produce different effects on immune function. If alkalization has, or not, some effect on inflammation control is still a matter of speculation. Studies concerning these subjects are limited justifying this paper.

Diaphragmatic hernia repair more than four years after severe trauma: Four case reports

Highlights • We treat four patients with delayed traumatic diaphragmatic hernia.• All surgeries were large and delicate clinical management.• All patients had excellent outcomes.• If these injuries had been diagnosed early surgical approaches would be less invasive.

Parasitic thyroid nodules in patient with nontoxic multinodular goiter: a case report.

IntroductionThe presence of benign thyroid tissue that is located on the side of the neck is extremely rare and not related to the development of the thyroid, and it is difficult to differentiate it from thyroid carcinoma metastasis.The parasitic thyroid nodule occurs when thyroid tissue located in the lateral neck has no relationship or association with the lymph nodes, and may be defined as a thyroid nodule entirely separate from the thyroid or attached to it by a narrow pedicle, presenting the same histology and in the same facial plane as the thyroid, and should not be associated with lymph nodes.Case presentationA 40-year-old Brazilian man without significant past medical history presented with a large volume multinodular thyroid goiter that caused deformity and symptoms suggestive of cervical spine compression. He underwent a total thyroidectomy. His thyroid function was normal. Ultrasonography showed a heterogeneous thyroid nodule measuring 3.7cm to the right from midline and 3.3cm to the left from midline that was associated with two nodules in the left submandibular area measuring 1.43cm and 1.52cm.Fine needle aspiration confirmed the benign nature of the gland and thyroid tissue etiology of the two submandibular nodules, located in level II of the neck. Since the ectopic thyroid tissue in his lateral neck was suggestive of metastasis of occult primary thyroid carcinoma, the patient underwent a total thyroidectomy plus a left modified radical neck dissection with preservation of level I. The diagnosis of multinodular goiter associated with two parasitic thyroid nodules was confirmed by immunohistochemistry.ConclusionsWe conclude that the parasitic thyroid nodule should be included in the differential diagnosis of lateral neck masses. The diagnosis and differentiation of these nodules from metastatic adenopathies of differentiated thyroid carcinoma has important therapeutic and prognostic implications, and can lead to avoidance of unnecessary surgeries.Introduction The presence of benign thyroid tissue that is located on the side of the neck is extremely rare and not related to the development of the thyroid, and it is difficult to differentiate it from thyroid carcinoma metastasis. The parasitic thyroid nodule occurs when thyroid tissue located in the lateral neck has no relationship or association with the lymph nodes, and may be defined as a thyroid nodule entirely separate from the thyroid or attached to it by a narrow pedicle, presenting the same histology and in the same facial plane as the thyroid, and should not be associated with lymph nodes.

Laringoscopia de suspensão para o cirurgião torácico: quando e como utilizá-la

Suspension laryngoscopy is one of the most common otolaryngological procedures for the diagnosis and surgical approach to the larynx. However, most thoracic surgeons are not familiar with the procedure and seldom use it. The indications for its use are similar to those for that of rigid bronchoscopy (dilatation, endoprosthesis insertion, and tumor resection). It can be performed in children and adults. Suspension laryngoscopy is an alternative when rigid bronchoscopy is unavailable and is therefore a viable option for use at smaller facilities. In this communication, we describe the technique and the applications of suspension laryngoscopy in thoracic surgery.

Toxoplasma gondii pseudocyst in a transbronchial biopsy: a case report

BackgroundWe herein present a case in which a Toxoplasma cyst was found in a transbronchial biopsy specimen from an immunocompetent patient with negative serology for the parasite.Case presentationAn 18-year-old Brazilian man presented with a 1-week history of dyspnea and fever and was diagnosed with right lower lobe pneumonia. He began inpatient treatment with intravenous antibiotics. During treatment, a bronchoscopy with bronchoalveolar lavage and transbronchial biopsy was performed. Anatomopathological examination of the transbronchial biopsy showed a small fragment of lung parenchyma with discrete septal thickening and a rounded structure, suggestive of a pseudocyst containing Toxoplasma gondii bradyzoites. However, serological tests were negative for immunoglobulin G and immunoglobulin M.ConclusionsBronchoscopy is a minimally invasive, effective diagnostic and therapeutic method. Despite the fact that the Toxoplasma pseudocyst in the present case was not the cause of the patient’s comorbidities, bronchoscopy with transbronchial biopsy allowed for an incidental diagnosis of a Toxoplasma pseudocyst with minimal invasiveness.

Effects of methylene blue in acute lung injury induced by oleic acid in rats.

BACKGROUND In acute lung injury (ALI), rupture of the alveolar-capillary barrier determines the protein-rich fluid influx into alveolar spaces. Previous studies have reported that methylene blue (MB) attenuates such injuries. This investigation was carried out to study the MB effects in pulmonary capillary permeability. METHODS Wistar rats were divided into five groups: (I) Sham: saline bolus; (II) MB, MB infusion for 2 h; (III) oleic acid (OA), OA bolus; (IV) MB/OA, MB infusion for 2 h, and at 5 min after from the beginning, concurrently with an OA bolus; and (V) OA/MB, OA bolus, and after 2 h, MB infusion for 2 h. After 4 h, blood, bronchoalveolar lavage (BAL), and lung tissue were collected from all groups for analysis of plasma and tissue nitric oxide, calculation of the wet weight to dry weight ratio (WW/DW), and histological examination of lung tissue. Statistical analysis was performed using nonparametric test. RESULTS Although favourable trends have been observed for permeability improvement parameters (WW/WD and protein), the results were not statistically significant. However, histological analysis of lung tissue showed reduced lesion areas in both pre- and post-treatment groups. CONCLUSIONS The data collected using this experimental model was favourable only through macroscopic and histological analysis. These observations are valid for both MB infusions before or after induction of ALI.

Hyperbaric oxygen therapy for primary sternal osteomyelitis: a case report

IntroductionPrimary osteomyelitis of the sternum is a rare condition, which accounts for 0.3% of all cases of osteomyelitis reported in the literature. The diagnosis requires a high degree of suspicion and confirmation by percutaneous biopsy. The treatment consists of resection of the periosteum and affected bone. Despite reports of successful conservative treatment using antibiotics alone, early surgical intervention plus bacterial control is the definitive treatment; it reduces morbidity, and is the most cost-effective approach for the patient. We report a case of primary osteomyelitis surgically treated with debridement and antibiotics, followed by hyperbaric oxygen therapy.Case presentationA 39-year-old Brazilian man without a significant medical history presented with primary osteomyelitis. After a normal chest radiograph and normal laboratory test results, he was treated with 2 weeks of nonsteroidal anti-inflammatory drugs. One month later a presumptive diagnosis of Tietze syndrome was made and he was prescribed prednisolone (60mg/day) for 3 weeks. The following month he presented to our service with swelling, redness, and warmth in the area between his left third and fourth ribs. Subsequent magnetic resonance imaging revealed a large collection of liquid (8.8×6.8×20.2cm) in his chest wall, between the body and the manubrium of the sternum. An area of soft, friable tissue with a large amount of pus was found in his sternum during surgical debridement. Subsequent treatment consisted of antibiotic therapy using metronidazole and cefotaxime plus hyperbaric oxygen therapy. On postoperative day 10 the incision was sutured. The patient was discharged on postoperative day 15 on a regimen of oral ciprofloxacin, and completed hyperbaric oxygen therapy as an out-patient.ConclusionsThe satisfying outcome of this patient reflects the quick action to promote surgical debridement and use of antibiotics, which are both recommended treatments. The closure of the wound in 10 days after debridement suggests that the hyperbaric oxygen therapy might have indirectly, but not conclusively, aided in the premature closure of the wound, avoiding a longer healing by second intention or muscle flap rotation closure.