RESUMEN
HYPOTHESIS: Vitamin E has interesting biological functions for the cosmetic and pharmaceutical industry because it can act as a fat-soluble antioxidant, as well as peroxyl radical scavenger. However, this vitamin is formed by a group of compounds that include tocopherols (γ-tocopherols, α-tocopherol) characterized by their poor solubility in water, what implies the need of using stabilizing agents such as biosurfactants or minerals, in order to make them soluble or stable in formulations composed by water and oil. EXPERIMENTS: In this work, it has been evaluated the synergic effect between a mining silicate mineral (mica) and a biosurfactant extract, obtained from corn steep liquor, to stabilize emulsions containing water and a non-aqueous soluble antioxidant consisting of Vitamin E, through the use of a triangular design. FINDINGS: The results show that the presence of biosurfactant extract improves the emulsion volume up to 70% after 22â¯days, for an emulsion composed of Vitamin E and biosurfactant, whereas the mica component was able to increase the emulsion stability until values of 80% after 30â¯days of experiment, for those emulsions containing 10% of mica. Hence, both novel ingredients produce a synergistic effect on the Pickering emulsions carried out in the study.
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Silicatos de Aluminio/química , Tensoactivos/química , Vitamina E/química , Emulsiones/química , Tamaño de la Partícula , Propiedades de SuperficieRESUMEN
The antimicrobial and anti-adhesive activities of the cell-bound biosurfactants, produced by Lactobacillus pentosus (PEB), characterized as glycolipopeptide macromolecules, were evaluated against several microorganisms present in the skin microflora, envisaging its potential use as a "natural" ingredient in cosmetic and personal care formulations. Their performance was compared with another cell-bound biosurfactants also characterized as glycolipopeptides produced by Lactobacillus paracasei (PAB). At concentrations of 50mg/mL, the PEB showed an important antimicrobial activity against Pseudomonas aeruginosa (85% when extracted with phosphate buffer (PB) and 100% when extracted with phosphate buffer saline (PBS)), Streptococcus agalactiae (100% for both extracts), Staphylococcus aureus (67% when extracted with PBS and 100% when extracted with PB), Escherichia coli (72% when extracted with PB and 89% when extracted with PBS), Streptococcus pyogenes (about 85% for both extracts) and Candida albicans (around 70% for both extracts), comparable with that obtained for the PAB. However, at lower concentrations the PAB exhibited in general higher antimicrobial activities. Biosurfactants produced by both microorganisms also showed significant anti-adhesive properties against all the microorganisms under study, except for E. coli and C. albicans (less than 30%). Overall, these cell-bound biosurfactants could be used as potential antimicrobial and anti-adhesive agents in cosmetic and pharmaceutical formulations.
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Antiinfecciosos/química , Antiinfecciosos/farmacología , Lipopéptidos/química , Lipopéptidos/farmacología , Tensoactivos/química , Tensoactivos/farmacología , Adhesión Bacteriana/efectos de los fármacos , Glicosilación , Lactobacillus/efectos de los fármacos , Pruebas de Sensibilidad MicrobianaRESUMEN
Resumen ANTECEDENTES: el delirio es un síndrome clínico transitorio y reversible, ocurre frecuentemente en el marco de un proceso de enfermedad aguda, se caracteriza por la alteración de la conciencia que se acompaña de un cambio en las funciones cognoscitivas, sobreviene a lo largo de un breve periodo, habitualmente horas o días, y tiende a fluctuar a lo largo del día. El delirio constituye un problema de salud pública importante, se considera predictor independiente de resultados clínicos negativos con incremento de la mortalidad, la estancia hospitalaria, el costo de la atención y el deterioro cognitivo a largo plazo. La evidencia disponible no apoya la administración de medicamentos para prevenir el delirio en el paciente con enfermedad aguda. OBJETIVO: comprobar la seguridad y eficacia de haloperidol para el tratamiento y profilaxis del delirio. MATERIAL Y MÉTODO: ensayo clínico controlado, prospectivo, transversal, comparativo, en el que se estudiaron pacientes hospitalizados en el servicio de Medicina Interna del Hospital General Xoco de la Secretaría de Salud de la Ciudad de México, se calculó la escala PREDELIRIC al ingreso de los pacientes; se incluyeron en el estudio los pacientes con riesgo alto de delirio (PREDELIRIC >50%). Los pacientes se distribuyeron al azar en dos grupos, en el grupo 1 se aplicaron medidas no farmacológicas de prevención de delirio más la administración de haloperidol profiláctico y el grupo 2 recibió medidas no farmacológicas de prevención de delirio más placebo. RESULTADOS: se incluyeron 84 pacientes, distribuidos en dos grupos, cada uno con 42 pacientes, de los que 33 (40%) eran hombres. El 42% padeció delirio, el tipo mixto fue el más común. La profilaxis con haloperidol no demostró disminuir la incidencia de delirio (54 vs 46%, p=0.51) en comparación con el grupo control. El haloperidol profiláctico no ofreció diferencias significativas comparado con placebo en retrasar el inicio del delirio (media de 6.3 vs 6.8 días, p=0.98), en los días de estancia hospitalaria (mediana 9.5 vs 12 días, p=0.56) o en la duración del delirio (media 3 vs 3.5 días, p=0.32); tampoco tuvo efecto en la mortalidad (20 vs 10%, p=0.21). No se informaron efectos secundarios con la administración de haloperidol. CONCLUSIONES: la administración de haloperidol para la prevención del delirio en pacientes con riesgo alto de padecerlo no demostró diferencia significativa en comparación con el placebo en disminuir la incidencia de delirio, en retrasar el inicio de los síntomas, en la reducción de su duración, en reducir los días de estancia hospitalaria ni en la mortalidad. De acuerdo con nuestros resultados, por el momento no es posible recomendar la administracion de haloperidol en la profilaxis de delirio en pacientes con riesgo alto de padecerlo.
Abstract BACKGROUND: Delirium is a clinical transitory and reversible syndrome, occurs frequently in a setting of an acute disease process, it is characterized by the disorder of the consciousness accompanied by a change in the cognitive functions, it occurs throughout a brief period, usually hours or days and tends to vary during the day. Delirium is an important public health problem and it is considered independent predictor of negative clinical results with increased mortality, hospital stay, attention cost and cognitive damage to long-term. The available evidence does not support the administration of drugs to prevent delirium in patients with acute disease. OBJECTIVE: To prove the safety and efficacy of haloperidol for the treatment and prophylaxis of delirium. MATERIAL AND METHOD: A clinical, controlled, prospective, cross-sectional, comparative study was done, in which patients hospitalized at Internal Medicine service of General Hospital Xoco, Mexico City, were included. Scale PREDELIRIC was calculated at the entering of patients, including in the study those with high risk of delirium (PRE-DELIRIC >50%). Patients were randomly distributed into two groups, in the group 1 non pharmacological measures of delirium prevention were applied plus the administration of prophylactic haloperidol and group 2 was given non pharmacological measures of delirium prevention plus placebo. RESULTS: There were included 84 patients, distributed into two groups, each one with 42 patients, from which 33 (40%) were male; 42% suffer delirium, mix type was the most common. Prophylaxis with haloperidol did not show to reduce the incidence of delirium (54% vs 46%, p=0.51) compared with control group. Prophylactic haloperidol did not show significant differences compared to placebo in delaying the beginning of delirium (mean of 6.3 days vs 6.8 days, p=0.98), in days of hospital stay (mean 9.5 vs 12 days, p=0.56), or in the lasting of delirium (mean 3 vs 3.5 days, p=0.32). Prophylaxis with haloperidol did not show either effect on mortality (20% vs 10%, p=0.21). There were not secondary effects with haloperidol. CONCLUSIONS: Haloperidol administration to prevent delirium in patients with high risk of having it did not show significant difference compared to placebo in reducing delirium incidence, delaying the starting of symptoms, in reducing their lasting, in reducing the hospital stay nor in reducing mortality. According to our results, by now it is not possible to recommend the administration of haloperidol in the prophylaxis of delirium in patients with high risk of having it.
RESUMEN
Resumen ANTECEDENTES: la prehipertensión es una condición que aumenta el riesgo de padecer hipertensión arterial. Las concentraciones séricas elevadas de ácido úrico se asocian con hipertensión arterial y dificultan su control. OBJETIVO: evaluar las concentraciones circulantes de ácido úrico en pacientes prehipertensos en comparación con las de sujetos normotensos e hipertensos. MATERIAL Y MÉTODO: estudio clínico transversal en el que de enero a junio de 2016 las concentraciones séricas de ácido úrico se determinaron por método enzimático en pacientes con prehipertensión (de acuerdo con los criterios del JNC VII), así como en sujetos normotensos y sujetos hipertensos. Los métodos estadísticos usados fueron ANOVA y prueba exacta de Fisher. RESULTADOS: se incluyeron 90 pacientes con prehipertensión, 90 sujetos normotensos y 90 sujetos hipertensos. Encontramos que el grupo de prehipertensos tuvo valores significativamente mayores de ácido úrico que los normotensos (6.24±1.5 mg/dL vs 5.4±1.2 mg/dL, p=0.000206), mientras que aunque los valores en hipertensos fueron superiores (6.7±2 mg/dL), no alcanzaron significación estadística con los prehipertensos (p=0.99). Encontramos asociación significativa entre hiperuricemia con prehipertensión (p=0.015 IC 95%; 1.18-3.99). CONCLUSIONES: los pacientes prehipertensos mostraron concentraciones de ácido úrico superiores a las de los normotensos y aunque los valores mencionados fueron menores que en los hipertensos, esto no fue significativo. La hiperuricemia puede contribuir, al menos en parte, a mayor progresión hacia hipertensión arterial observada en los prehipertensos.
Abstract BACKGROUND: Prehypertension increases the risk of hypertension, serum uric acid levels are also associated with increased risk of hypertension. Increased levels of resistin and/or decreased levels of adiponectin are associated with cardiovascular mortality and the development of hypertension. OBJECTIVE: To evaluate uric acid serum levels in normotensive, prehypertensive and hypertensive patients. MATERIAL AND METHOD: A clinical, cross-sectional study was made from January to June 2016 in which circulating levels of uric acid were measured (enzymatic method) in normotensive, prehypertensive and hypertensive patients. Statistical analysis was performed with ANOVA and Fisher test. RESULTS: Ninety normotensive, 90 prehypertensive and 90 hypertensive patients were included. Prehypertensive patients have significantly greater levels of uric acid than normotensive subjects (6.24±1.5 mg/dL vs 5.4±1.2 mg/dL, p=0.000206). We also observed that hypertensive patients had increased, although non-significantly, values of uric acid than prehypertensive subjects (6.7±2 mg/dL, p=0.99). We also found a significantly association between hyperuricemia and prehypertension (p=0.015 IC 95%; 1.18-3.99). CONCLUSIONS: Prehypertensive patients had greater levels of uric acid when compared with normotensive subjects, this may explain why prehypertensive patients shown increased risk for hypertension than normotensive patients.
RESUMEN
In the last few years the awareness of consumers and institutions about the impact that our industrial processes has on health and the environment has increased, demanding more natural products. In this work, a multifunctional bioactive extract with surfactant and antioxidant properties, composed mainly of C16 and C18 fatty acids, and phenolic compounds (vanillic acid, p-coumaric acid, ferulic acid, sinapic acid and quercetin) was obtained from corn steep liquor (CSL). Different liquid-liquid extraction protocols were evaluated obtaining a natural extract, which was able to reduce the surface tension of water by more than 30 units, showing antioxidant activity with an EC50 of 8.51 mg mL(-1) and a yield of 6.85 g of extract per kg of CSL. Additionally, it was observed that after liquid-liquid extraction with chloroform, the aqueous phase can be subjected to a hydrothermal treatment, followed by extraction with ethyl acetate, in order to obtain another extract (24.7 g of extract per kg of CSL) with a higher antioxidant capacity (EC50 of 4.02 mg mL(-1)). In this case the antioxidant extract is composed of protocatechuic acid, vanillic acid, caffeic acid, epicatechin, p-coumaric acid, ferulic acid, sinapic acid and quercetin.
Asunto(s)
Antioxidantes , Manipulación de Alimentos , Residuos Industriales , Tensoactivos , Zea mays/química , Ácidos Cafeicos/análisis , Catequina/análisis , Ácidos Cumáricos/análisis , Hidroxibenzoatos/análisis , Fenoles/análisis , Propionatos/análisis , Quercetina/análisis , Ácido Vanílico/análisisRESUMEN
Objetivo: Determinar, mediante simulación con elementos finitos (MEF), la adecuación de la fijación con tornillo biocompatible del fascículo posterolateral (PL) en las reparaciones de ligamento cruzado anterior (LCA) con técnica bifascicular y único túnel tibial. Material y método: Se realizó un estudio mediante MEF de las tensiones sufridas del material de fijación (Endobutton ® y Biosure HA®) y del componente óseo en reparaciones del LCA mediante la técnica bifascicular y único túnel tibial. Resultados: Las fuerzas ejercidas sobre las fijaciones sobre el componente óseo están dentro de los límites admisibles por el hueso y por los materiales de fabricación de las fijaciones, tanto en la zona de anclaje como en fémur distal. Conclusión: La fijación del fascículo PL con un tornillo biocompatible en la reconstrucción del LCA con técnica bifascicular y único túnel tibial asegura un comportamiento mecánico adecuado para cuando la rodilla del paciente va a ser intensivamente rehabilitada (AU)
Objective: To determine, through finite element simulation (FEM), the adaptation of the posterolateral (PL) fascicle fixation by means of a biocompatible screw for anterior cruciate ligament (ACL) repairs when using the bifascicular technique with a single tibial tunnel. Material and method: It has been performed a finite element study in order to analyse the stress suffered by both material fixation (Endobutton® and Biosure HA®), and the bone component in ACL repairs using the bifascicular technique with a single tibial tunnel. Results: The simulation carried out shows that the forces exerted over the fixations and the bone are within the allowable limits for the bone and the manufacture material of the fixing devices, both at the anchorage area and at distal femur. Conclusion: The fixation of the PL fascicle by means of a biocompatible screw Biosure HA® in ACL repairs, when using the bifascicular technique with a single tibial tunnel, allows ensuring a proper mechanical behaviour when patient's knee is going to be intensively rehabilitated (AU)
Asunto(s)
Humanos , Masculino , Femenino , Ligamento Cruzado Anterior/lesiones , Ligamento Cruzado Anterior/cirugía , Fijación Intramedular de Fracturas/métodos , Fijación Intramedular de Fracturas/tendencias , Fijación Intramedular de Fracturas , Fijadores Internos , /métodosRESUMEN
Objetivo: determinar, mediante la simulación con elementos finitos, las diferencias mecánicas del túnel femoral en las reparaciones del ligamento cruzado anterior (LCA), con técnicas mono y bifasciculares con un único túnel tibial. Material y Método: se realizó un estudio mediante elementos finitos de las tensiones sufridas en el material de fijación (Endobutton® y Endobutton direct®), como del componente óseo, en las reparaciones del LCA mediante la técnica monofascicular y bifascicular con un único túnel tibial. Se simuló la resistencia a la compresión del extremo distal del fémur tras la realización de los túneles. Resultados: las fuerzas sufridas tanto por el material de fijación como por el componente óseo estaban dentro de los límites de tolerancia de ambos materiales en todos los supuestos estudiados, tanto en la zona de anclaje como en el fémur distal. Conclusiones: la realización de mayor número de túneles en la reconstrucción del LCA no supone un riesgo de rotura del material ni de fractura ósea (AU)
Objetive: To use finite elements simulation to determine the mechanical differences of the femoral tunnel in monofascicular and bifascicular anterior cruciate ligament (ACL) repair with a single tibial tunnel. Material and method: A finite elements study was made of the tension experienced in the fixation material (Endobutton® and Endobutton direct®) and bone component in monofascicular and bifascicular ACL repair with a single tibial tunnel. Resistance to compression of the distal extremity of the femur was simulated aftercreating the tunnels. Results: The forces experienced by the fixation material and bone component were within the limits of tolerance of both materials in all the studied scenarios, in both the anchoring zone and in the distal femur. Conclusions: The creation of an increased number of tunnels in ACL reconstruction does not imply a risk of material rupture or bone fracture (AU)
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Humanos , Masculino , Femenino , Ligamento Cruzado Anterior/lesiones , Ligamento Cruzado Anterior/cirugía , Ortopedia/tendencias , Ligamento Cruzado Anterior , Tibia/fisiopatología , Fracturas de la Tibia/terapia , Fracturas de la TibiaRESUMEN
Introducción: La rotura del tendón de Aquiles es una patología relativamente frecuente a partir de la cuarta década de la vida. El uso de plasma rico en factores de crecimiento (PRGF) favorece la rápida reparación de las partes blandas, una vez han sido suturadas. Pacientes y método: Dos series de 11 pacientes intervenidos en dos centros diferentes de FREMAP (Gijón y San Sebastián). Cada serie ha sido intervenida por el mismo cirujano estandarizando la técnica a emplear. En ambas series se ha añadido plasma rico en factores de crecimiento a la reparación. Se analiza el resultado al Alta según la escala de valoración de la AOFAS (American Orthopaedic Foot and Ankle Society). Resultados: La serie de Gijón (Serie I) alcanzó un resultado en la escala AOFAS de 97,08 puntos, con un período de curación de 15,09 semanas. La serie de San Sebastián (Serie II) alcanzó un resultado en la escala AOFAS de 91,08 puntos con un período de curación de 11 semanas. En ambas series se consiguió la recuperación completa de la función y la vuelta a la actividad deportiva previa a la rotura. Conclusión: El uso de plasma rico en factores de crecimiento acorta considerablemente el período de curación, consigue una reparación ad integrum de la rotura del tendón de Aquiles y evita las complicaciones clásicas de esta cirugía. Los autores recomiendan encarecidamente el uso de esta técnica
Purpose: The rupture of the Achilles tendon is a relatively common pathology after the forties. The use of plasma rich in growth factors (PRGF) contributes to the fast repair of the soft tissues, once they have been sutured. Materials and methods: Two series of 11 patients operated in two different FREMAP hospitals (Gijón and San Sebastián, Spain). Each serie has been operated by the same surgeon using the same technique in all the cases. In both series, plasma rich in growth factors has been used to the repair. The result is analized at the discharge according to the American Orthopaedic Foot and Ankle Society (AOFAS) scale. Results: According to the AOFAS scale, the serie of Gijón had a result of 97.08 points, with a healing period of 15.9 weeks. The serie of San Sebastián had a result of 91.08 points with a healing period of 11 weeks. In both series the total recovery of the function and the back to sporting activities before the rupture were achieved. Conclusion: The use of plasma rich in growth factors reduces considerably the healing period, achieves a restitutio ad integrum of the rupture of the Achilles tendon and it avoids the typical complications of this surgery. The authors recommend insistently the use of this technique
Asunto(s)
Humanos , Tendón Calcáneo/cirugía , Traumatismos de los Tendones/cirugía , Recuperación de la Función/fisiología , InmovilizaciónRESUMEN
Objetivo: valorar la eficacia de un método de valoraciónde Calidad de Vida en los pacientes con degeneraciónarticular de la rodilla.Procedimiento: se ha realizado un estudio en base alconcepto de CVRS en pacientes diagnosticados de un cuadroclínico-radiológico de artrosis de rodilla en los que seha procedido a la indicación de una artroplastia total derodilla.Resultados: Se determino un Grupo de Estudio (GE) de66 pacientes, siendo el 18.18% hombres y el 81.82% mujeresy un Grupo Control de 562 individuos.La medida se realizó mediante el método PECVEC, analizandola capacidad Física, Función Psicológica, Estado deAnimo Positivo y Negativo, Funcionamiento Social y BienestarSocial con un rango de puntuación que va desde 0 a4 (puntuación máxima), realizándose un análisis estadísticode los datos obtenidos.Obtenido un coeficiente alfa de Cronbach en todos loscasos mayor de 0,70, se encontró que los valores obtenidosen el GE tanto para Hombres como para Mujeres fueronsiempre menores en todas las escalas comparativamentecon los valores obtenidos en el GC, y siendo laFunción Física la escala mas deteriorada (con significaciónestadística) frente a la del Bienestar Social, apreciándosetodas las escalas de las puntuaciones del grupo de Mujeressiempre inferiores a las del grupo de Hombres.Conclusiones: El PECVEC es útil para medir la Calidadde Vida en pacientes con gonartrosis, presentando los hombresun menor descenso de la Calidad de Vida respecto a lasmujeres, y originando ésta patología un idéntico deteriorode la calidad de vida que otras patologías crónicas
Objective: to value the effectiveness of a method ofvaluation of the Quality of Life in the patients witharthritic on the knee.Procedure: a study on the basis of the CVRS concepthas been made in patients diagnosed of a clinica andradiological signs of knee arthritis, in which a kneearthroplasty has been come to the total indication of one.Results: It was divided on an Study Group (GE) of 66patients, being the 18,18% men and the 81,82% womenand a Control Group of 562 individuals.The measurement was made by means of PECVECmethod, analyzing the Physical Conditioning,Psychological Function, State of Spirit to Positive andNegative, Health and Social Welfare with a score rank thatgoes from 0 to 4 (Maximum score), being made anstatistical analysis of the collected data.Obtained a coefficient alpha of Cronbach in all thecases greater of 0.70, one as much was that the valuesobtained in GE for Men as for Women they were alwayssmaller in all the scales comparatively with the valuesobtained in the GC, and being the Physical Scale the mostdeteriorated Function (with statistical meaning) asopposed to the one of the Social welfare, being appraisedall the scales of the scores always inferior in Women tothose of the group of Men.Conclusions: The PECVEC is useful to measure theQuality of Life in patients with gonartrosis, showing themen a smaller reduction of the Quality of Life with respectto the women, and originating this one pathology anidentical deterioration of the quality of life that otherchronic pathologies
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Masculino , Femenino , Humanos , Osteoartritis de la Rodilla/rehabilitación , Perfil de Impacto de Enfermedad , Artroplastia de Reemplazo de Rodilla , Estudios de Casos y Controles , Encuestas y CuestionariosRESUMEN
No disponible
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Masculino , Humanos , Ciclismo/lesiones , Traumatismos en Atletas/diagnóstico , Tenosinovitis/diagnóstico , Traumatismos de los Tendones/diagnósticoRESUMEN
Sixty patients with a hypertensive emergency (mean arterial pressure >130 mm Hg and evidence of target organ damage) were randomly divided into two groups of 30 patients each. Group A received 1.25 mg of isosorbide dinitrate aerosol upon arrival and a second dose 15 minutes later when the mean arterial pressure reduction was < 15%. Group B received a single 5 mg tablet of sublingual isosorbide dinitrate. Electrocardiography was performed in both groups prior to and 30 minutes after the medication. Blood pressure was monitored for 6 hours. Blood pressure in Group A patients decreased in an average time of 10 minutes from 191 +/- 12/122.3 +/- 5 to 151.5 +/- 9.2/93 +/- 4 mm Hg, p < 0.005. Mean arterial pressure decreased by 22.8%: 145 +/- 7 to 112 +/- 7.5 mm Hg, p < 0.005. No adverse effects occurred. Five patients in Group B did not respond; in the rest of the group blood pressure decreased 45 minutes after receiving the medication from 194 +/- 8/125 +/- 5.5 to 160 +/- 11/98 +/- 6 mm Hg; p < 0.005. Mean arterial pressure decreased by 20.1%: 148.3 +/- 12 to 118.6 +/- 9 mm Hg, p < 0.002; ten patients suffered headache. Three patients in Group A had a subepicardial lesion in the first electrocardiograph, which disappeared with the use of the aerosol. In Group B, electrocardiography results were normal. These results seem to indicate that isosorbide dinitrate aerosol is better than tablets for the treatment of patients with a hypertensive emergencies.
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Aerosoles , Hipertensión/tratamiento farmacológico , Dinitrato de Isosorbide/administración & dosificación , Vasodilatadores/administración & dosificación , Administración por Inhalación , Administración Oral , Presión Sanguínea/efectos de los fármacos , Electrocardiografía , Urgencias Médicas , Femenino , Humanos , Dinitrato de Isosorbide/uso terapéutico , Masculino , Persona de Mediana Edad , Vasodilatadores/uso terapéuticoRESUMEN
The aim of this study was to determine the frequency of white-coat hypertension in geriatric subjects with isolated systolic hypertension. We included 80 elderly patients with a previous diagnosis of isolated systolic hypertension, who performed self-measurement of blood pressure at home during 3 days after a 2-week washout period. Patients with home blood pressure values <135/85 performed a second self-measurement of blood pressure one month later. We found that 20 patients (25%, 18 women, RR=2.6), showed normal blood pressure values at home in both studies of self-measurement. Knowledge of the prevalence of white-coat hypertension is important for adequate diagnosis, and to avoid the use of unnecessary antihypertensive drugs.
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Determinación de la Presión Sanguínea , Hipertensión/epidemiología , Enfermedad Iatrogénica , Anciano , Determinación de la Presión Sanguínea/psicología , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/etiología , Masculino , Persona de Mediana Edad , Prevalencia , SístoleRESUMEN
In this clinical trial, we assessed the effectiveness and safety of isosorbide dinitrate spray administered through the oral mucosa in 20 elderly patients (> 60 years old) with a hypertensive emergency (mean arterial pressure > 140 mmHg and target-organ damage). The patents were given a first dose of 1.25 mg of spray when they were admitted; a second dose was administered 15 min. later if the mean arterial pressure had not decreased by > 15%. An electrocardiogram (ECG) was done on every patient immediately prior and 30 min. after administering the medication. Three patients (15%) had a good response with one dose while 17 patients (85%) required a second dose. Thirty patients had a significant reduction in arterial blood pressure (193 +/- 91,123 +/- 5.4 to 154 + 7.1/92.5 + 6.2 mmHg p < 0.005) as well as of the mean arterial pressure (146.8 +/- B to 113 +/- 5 mmHg 23%, p < 0.005 > in a period of 30 min. No adverse effects, rebound hypertension nor severe hypotension were observed. These figures remained under control for 3 h. Both ECG, were normal. A reduction of 13.5% heart rate was obtained (p < 0.005). Our observations suggest that isosorbide dinitrate aerosol is an effective and safe alternative for the treatment of elderly patients with hypertensive emergencies.
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Hipertensión/tratamiento farmacológico , Dinitrato de Isosorbide/administración & dosificación , Vasodilatadores/administración & dosificación , Factores de Edad , Anciano , Urgencias Médicas , Femenino , Humanos , Masculino , Nebulizadores y VaporizadoresRESUMEN
BACKGROUND: Isosorbide dinitrate in spray form is an effective and safe option for the treatment of hypertensive emergencies. The aim of this study was to evaluate whether isosorbide dinitrate spray is as effective and safe as treatment in tablet form for the management of hypertensive emergencies in the elderly. METHODS: Forty patients with hypertensive emergencies were randomly divided into two groups of 20 patients each. Group A received 1.25 mg isosorbide dinitrate aerosol upon arrival and a second dose 15 min later when mean systemic arterial pressure (MAP) reduction was <15% . Group B patients received a single 5 mg tablet of sublingual isosorbide dinitrate. RESULTS: Blood pressure in Group A patients decreased from 193 +/- 13/123 +/- 6.6 mmHg to 154 +/- 15/92.5 +/- 7.6 mmHg (p < 0.005), the reduction beginning 10 min after drug administration; no adverse effects were found. Two patients in Group B did not respond but for the other patients in this group blood pressure decreased from 197 +/- 10/121 +/- 7 to 154 +/- 11/90 +/- 4 mmHg, (p < 0.005), the reduction beginning 45 min after receiving the medication; 8 patients suffered headache. CONCLUSION: Our results indicate that isosorbide dinitrate aerosol is more effective than tablets for the treatment of elderly patients with hypertensive emergencies.
Asunto(s)
Antihipertensivos/administración & dosificación , Urgencias Médicas , Hipertensión/tratamiento farmacológico , Dinitrato de Isosorbide/administración & dosificación , Vasodilatadores/administración & dosificación , Aerosoles , Anciano , Anciano de 80 o más Años , Antihipertensivos/efectos adversos , Antihipertensivos/uso terapéutico , Femenino , Cefalea/inducido químicamente , Humanos , Dinitrato de Isosorbide/efectos adversos , Dinitrato de Isosorbide/uso terapéutico , Masculino , Seguridad , Comprimidos , Resultado del Tratamiento , Vasodilatadores/efectos adversos , Vasodilatadores/uso terapéuticoRESUMEN
BACKGROUND: Nitric oxide donors have been used in the management of hypertensive emergencies (HE). Isosorbide dinitrate aerosol (ISA) is a nitric oxide fast-acting donor. The aim of this study is to compare the efficacy of ISA and nifedipine in the treatment of HE. METHODS: Sixty adult patients with an HE were randomised to receive either ISA (2.5 mg) or nifedipine (10 mg). Patients were given an electrocardiogram (ECG) immediately prior, and 30 min after administering the medication. Blood pressure (BP) was measured every 5 min for the first 30 min, and then every 30 min for a period of 6 h. RESULTS: Blood pressure values for all patients in the ISA group decreased significantly (187 +/- 13/121 +/- 6 to 153 +/- 15/92.3 +/- 7.6 mmHg, P < 0.005). Two of the patients in this group had angor pectoris with evidence of subepicardial ischaemia as seen in the first ECG, both of which disappeared with the drug. Heart rate decreased by 14%. Similarly, all patients in the nifedipine group had significant decreases in BP (190 +/- 23/115 +/- 7 to 153 +/- 26/86 +/- 6 mm Hg, P < 0.005). Their first ECG was normal. Two patients suffered angor pectoris after nifedipine, with subepicardial ischaemia registering in the second ECG. Heart rate increased 11.9% in this group. During the follow-up period, no clinically significant side effects or cases of rebound hypertension were observed in the ISA group, whereas in the nifedipine group, eight patients reported having headaches and four others rebound hypertension. CONCLUSION: Our results show a favourable effect of ISA in the treatment of HE.
Asunto(s)
Bloqueadores de los Canales de Calcio/uso terapéutico , Servicios Médicos de Urgencia , Hipertensión/tratamiento farmacológico , Dinitrato de Isosorbide/administración & dosificación , Nifedipino/uso terapéutico , Donantes de Óxido Nítrico/administración & dosificación , Adulto , Presión Sanguínea/efectos de los fármacos , Presión Sanguínea/fisiología , Bloqueadores de los Canales de Calcio/efectos adversos , Electrocardiografía , Femenino , Humanos , Hipertensión/fisiopatología , Dinitrato de Isosorbide/efectos adversos , Dinitrato de Isosorbide/uso terapéutico , Masculino , Persona de Mediana Edad , Nifedipino/efectos adversos , Donantes de Óxido Nítrico/efectos adversos , Donantes de Óxido Nítrico/uso terapéutico , Resultado del TratamientoRESUMEN
In this study the authors assessed the effectiveness and safety of isosorbide dinitrate aerosol administered through the oral mucosa in 30 adult patients who presented with a hypertensive crisis (mean arterial pressure > 130 mm Hg and evidence of target organ damage). The patients were given a first dose of 1.25 mg of aerosol when they were admitted to the hospital; a second dose was administered 15 minutes later if the mean arterial pressure had not decreased by > 15%. An electrocardiogram (ECG) was obtained for every patient immediately prior to and 30 minutes after administration of the medication. Nine patients (30%) had a good response with one dose, whereas 21 patients (70%) required a second dose. All 30 patients had a significant reduction of the arterial blood pressure (187+/-13 / 121+/-6.6 to 153+/-15.3 / 92.3+/-7.6 mm Hg; p<0.005) as well as of the mean arterial pressure (136.6+/-8 to 109.5+/-7 mm Hg; p<0.005) in a period of 30 minutes. No adverse effects, rebound hypertension, or severe hypotension were observed. These figures remained under control for 6 hours. Two of the patients had angina pectoris at admission and their ECG showed subepicardial ischemia, both of which disappeared with the medication. A second ECG appeared normal. A reduction of 14% in heart rate was obtained (95+/-15 to 82+/-14 beats per minute; p<0.005). These observations suggest that isosorbide dinitrate aerosol is an effective and safe alternative for the treatment of patients with hypertensive crises.