RESUMEN

Alzheimer's disease is the most common neurodegenerative disease, and its treatment is lacking. In this work, we tested Amylovis-201, a naphthalene-derived compound, as a possible therapeutic candidate for the treatment of AD. For this purpose, we performed three experiments. In the first and third experiment, animals received a bilateral administration of streptozotocin and, starting 24 h after injection, a daily dose of Amylovis-201 (orally), for 17 days or for the whole time of the experiment respectively (28 days), after which learning and memory, as well as the number of hippocampal dentate gyrus cells, were assessed. In the second experiment, healthy animals received a single dose of Amylovis-201, 10 min or 5 h after the learning section to assess whether this substance could promote specific mechanisms involved in memory trace formation. Our data show that, administration of a single dose of Amylovis-201, 10 min after the end of training, but not at 5 h, produces a prolongation in memory duration, probably because it modulates specific mechanisms involved in memory trace consolidation. Furthermore, daily administration of Amylovis-201 to animals with bilateral intracerebroventricular injection of STZ produces a reduction in the loss of the hippocampus dentate gyrus cells and an improvement in spatial memory, probably because Amylovis-201 can interact with some of the protein kinases of the insulin signaling cascade, also involved in neural plasticity, and thereby halt or reverse some of the effects of STZ. Taking to account these results, Amylovis-201 is a good candidate for the therapeutic treatment of AD.

Asunto(s)

Enfermedad de Alzheimer , Enfermedades Neurodegenerativas , Animales , Estreptozocina/farmacología , Enfermedades Neurodegenerativas/metabolismo , Modelos Animales de Enfermedad , Hipocampo/metabolismo , Memoria Espacial , Trastornos de la Memoria/metabolismo , Aprendizaje por Laberinto

RESUMEN

The number of people with dementia worldwide is estimated at 50 million by 2018 and continues to rise mainly due to increasing aging and population growth. Clinical impact of current interventions remains modest and all efforts aimed at the identification of new therapeutic approaches are therefore critical. Previously, we showed that JM-20, a dihydropyridine-benzodiazepine hybrid molecule, protected memory processes against scopolamine-induced cholinergic dysfunction. In order to gain further insight into the therapeutic potential of JM-20 on cognitive decline and Alzheimer's disease (AD) pathology, here we evaluated its neuroprotective effects after chronic aluminum chloride (AlCl3) administration to rats and assessed possible alterations in several types of episodic memory and associated pathological mechanisms. Oral administration of aluminum to rodents recapitulates several neuropathological alterations and cognitive impairment, being considered a convenient tool for testing the efficacy of new therapies for dementia. We used behavioral tasks to test spatial, emotional- associative and novel object recognition memory, as well as molecular, enzymatic and histological assays to evaluate selected biochemical parameters. Our study revealed that JM-20 prevented memory decline alongside the inhibition of AlCl3 -induced oxidative stress, increased AChE activity, TNF-α and pro-apoptotic proteins (like Bax, caspase-3, and 8) levels. JM-20 also protected against neuronal damage in the hippocampus and prefrontal cortex. Our findings expanded our understanding of the ability of JM-20 to preserve memory in rats under neurotoxic conditions and confirm its potential capacity to counteract cognitive impairment and etiological factors of AD by breaking the progression of key steps associated with neurodegeneration.

Asunto(s)

Cloruro de Aluminio/toxicidad , Benzodiazepinas/farmacología , Trastornos de la Memoria/inducido químicamente , Memoria/efectos de los fármacos , Neuronas/efectos de los fármacos , Fármacos Neuroprotectores/farmacología , Niacina/análogos & derivados , Cloruro de Aluminio/antagonistas & inhibidores , Animales , Hipocampo/efectos de los fármacos , Masculino , Aprendizaje por Laberinto/efectos de los fármacos , Trastornos de la Memoria/tratamiento farmacológico , Mitocondrias/efectos de los fármacos , Prueba del Laberinto Acuático de Morris/efectos de los fármacos , Niacina/farmacología , Prueba de Campo Abierto/efectos de los fármacos , Corteza Prefrontal/efectos de los fármacos , Ratas , Ratas Wistar , Prueba de Desempeño de Rotación con Aceleración Constante

RESUMEN

The aggregation of ß-amyloid peptides is associated to neurodegeneration in Alzheimer's disease (AD) patients. Consequently, the inhibition of both oligomerization and fibrillation of ß-amyloid peptides is considered a plausible therapeutic approach for AD. Herein, the synthesis of new naphthalene derivatives and their evaluation as anti-ß-amyloidogenic agents are presented. Molecular dynamic simulations predicted the formation of thermodynamically stable complexes between the compounds, the Aß1-42 peptide and fibrils. In human microglia cells, these compounds inhibited the aggregation of Aß1-42 peptide. The lead compound 8 showed a high affinity to amyloid plaques in mice brain ex vivo assays and an adequate log Poct/PBS value. Compound 8 also improved the cognitive function and decreased hippocampal ß-amyloid burden in the brain of 3xTg-AD female mice. Altogether, our results suggest that 8 could be a novel therapeutic agent for AD.

Asunto(s)

Enfermedad de Alzheimer/tratamiento farmacológico , Péptidos beta-Amiloides/antagonistas & inhibidores , Naftalenos/farmacología , Fármacos Neuroprotectores/farmacología , Fragmentos de Péptidos/antagonistas & inhibidores , Agregado de Proteínas/efectos de los fármacos , Agregación Patológica de Proteínas/tratamiento farmacológico , Enfermedad de Alzheimer/metabolismo , Péptidos beta-Amiloides/metabolismo , Animales , Astrocitos/efectos de los fármacos , Astrocitos/metabolismo , Relación Dosis-Respuesta a Droga , Ratones , Ratones Endogámicos C57BL , Simulación de Dinámica Molecular , Estructura Molecular , Naftalenos/síntesis química , Naftalenos/química , Fármacos Neuroprotectores/síntesis química , Fármacos Neuroprotectores/química , Fragmentos de Péptidos/metabolismo , Agregación Patológica de Proteínas/metabolismo , Relación Estructura-Actividad , Termodinámica

RESUMEN

OBJECTIVE: JM-20, a novel hybrid synthetic molecule, has been reported to have antioxidant, mitoprotective, anti-excitotoxic, anti-apoptotic and anti-inflammatory properties. However, the neuroprotective effect of JM-20 against memory impairment in preclinical AD-like models has not been analyzed. The aim of this study was to evaluate the potential neuroprotection of JM-20 that preserves essential memory process from cholinergic dysfunction and other molecular damages. METHODS: The effects of JM-20 on scopolamine (1 mg/kg)-induced cognitive disorders were studied. Male Wistar rats (220-230 g) were treated with JM-20 and/or scopolamine, and behavioral tasks were performed. The AChE activity, superoxide dismutase activity, catalase activity, MDA and T-SH level on brain tissue were determined by spectrophotometric methods. Mitochondrial functionality parameters were measured after behavioral tests. Histological analyses on hippocampus and prefrontal cortex were processed with hematoxylin and eosin, and neuronal and axonal damage were determined. RESULTS: The behavioral, biochemical and histopathological studies revealed that oral pre-treatment with JM-20 (8 mg/kg) significantly attenuated the scopolamine-induced memory deficits, mitochondrial malfunction, oxidative stress, and prevented AChE hyperactivity probably due to specific inhibition of AChE enzyme. It was also observed marked histological protection on hippocampal and prefrontal-cortex regions. CONCLUSIONS: The multimodal action of this molecule could mediate the memory protection here observed and suggest that it may modulate different pathological aspects of memory deficits associated with AD in humans.

Asunto(s)

Benzodiazepinas/farmacología , Inhibidores de la Colinesterasa/farmacología , Disfunción Cognitiva/tratamiento farmacológico , Memoria/efectos de los fármacos , Niacina/análogos & derivados , Nootrópicos/farmacología , Acetilcolinesterasa/metabolismo , Animales , Antioxidantes/metabolismo , Encéfalo/efectos de los fármacos , Encéfalo/metabolismo , Encéfalo/patología , Disfunción Cognitiva/metabolismo , Disfunción Cognitiva/patología , Modelos Animales de Enfermedad , Relación Dosis-Respuesta a Droga , Peroxidación de Lípido/efectos de los fármacos , Peroxidación de Lípido/fisiología , Masculino , Memoria/fisiología , Trastornos de la Memoria/tratamiento farmacológico , Trastornos de la Memoria/metabolismo , Trastornos de la Memoria/patología , Mitocondrias/efectos de los fármacos , Mitocondrias/metabolismo , Niacina/farmacología , Distribución Aleatoria , Ratas Wistar , Escopolamina

RESUMEN

OBJECTIVE: Scopolamine (SCO) administration to rats induces molecular features of AD and other dementias, including impaired cognition, increased oxidative stress, and imbalanced cholinergic transmission. Although mitochondrial dysfunction is involved in different types of dementias, its role in cognitive impairment induced by SCO has not been well elucidated. The aim of this work was to evaluate the in vivo effect of SCO on different brain mitochondrial parameters in rats to explore its neurotoxic mechanisms of action. METHODS: Saline (Control) or SCO (1 mg/kg) was administered intraperitoneally 30 min prior to neurobehavioral and biochemical evaluations. Novel object recognition and Y-maze paradigms were used to evaluate the impact on memory, while redox profiles in different brain regions and the acetylcholinesterase (AChE) activity of the whole brain were assessed to elucidate the amnesic mechanism of SCO. Finally, the effects of SCO on brain mitochondria were evaluated both ex vivo and in vitro, the latter to determine whether SCO could directly interfere with mitochondrial function. RESULTS: SCO administration induced memory deficit, increased oxidative stress, and increased AChE activities in the hippocampus and prefrontal cortex. Isolated brain mitochondria from rats administered with SCO were more vulnerable to mitochondrial swelling, membrane potential dissipation, H2O2 generation and calcium efflux, all likely resulting from oxidative damage. The in vitro mitochondrial assays suggest that SCO did not affect the organelle function directly. CONCLUSION: In conclusion, the present results indicate that SCO induced cognitive dysfunction and oxidative stress may involve brain mitochondrial impairment, an important target for new neuroprotective compounds against AD and other dementias.

Asunto(s)

Trastornos de la Memoria/metabolismo , Mitocondrias/metabolismo , Acetilcolinesterasa/metabolismo , Animales , Encéfalo/metabolismo , Calcio/metabolismo , Cationes Bivalentes/metabolismo , Modelos Animales de Enfermedad , Peróxido de Hidrógeno/metabolismo , Masculino , Aprendizaje por Laberinto/fisiología , Potencial de la Membrana Mitocondrial/fisiología , Dilatación Mitocondrial/fisiología , Estrés Oxidativo/fisiología , Distribución Aleatoria , Ratas Wistar , Reconocimiento en Psicología/fisiología , Escopolamina

RESUMEN

Antecedentes: Las neoplasias apendiculares estan presentes en menos del 1% de las apendicectomías. Los linfomas primarios del apéndice son raros ocurriendo en 0.015% de todos los linfomas gastrointestinales. La edad promedio para diagnóstico de los linfomas gastrointestinales es 55 años. En el apéndice cecal se encuentran en la segunda y tercera década de la vida. Es más común en hombres. La manifestación más común es la apendicitis aguda secundaria a obstrucción luminal. Caso clínico: Este es el primer caso reportado en la literatura hondureña. Se trata de una paciente de 67 años que ingresa al Hospital Escuela Universitario de Tegucigalpa, Honduras, con cuadro de dolor abdominal de dos semanas de evolución y sepsis por peritonitis generalizada secundaria a apendicitis aguda complicada. En el transoperatorio se identifican hallazgos compatibles con mucocele pero en la biopsia se diagnostica linfoma difuso de células grandes. El estudio inmunohistoquímico revela positividad para CD20. La evolución postoperatoria de la paciente fue tórpida hacia falla multiorgánica y los familiares decidieron exigir el alta para retornar a su lugar de origen. Conclusión: Aunque las neoplasias apendiculares son infrecuentes, siempre es necesario tener presente el diagnóstico al momento de realizar una apendicectomía, puesto que esto cambia el pronóstico y tratamiento...(AU)

Asunto(s)

Humanos , Femenino , Anciano , Apendicectomía/métodos , Neoplasias del Apéndice/clasificación , Apéndice , Neoplasias Gastrointestinales

RESUMEN

The aim of the present work was to investigate the anti-inflammatory and antinociceptive effects of methanolic extract from D. obtusata using classic models in mice (croton oil-induced ear edema and acetic acid-induced writhing) and a phospholipase A2 activity test. Qualitative analysis of the chemical composition of seaweed was also determined by extraction with solvents of increasing polarity and precipitation and color tests. Results of qualitative chemical study showed the presence of lactonic and phenolic compounds, reduced carbohydrates, other sugars, flavonoids, fatty compounds, triterpenes and steroids. The extract inhibited mouse ear edema in a dose-dependent manner with an efficacy higher than 90% and a mean effective dose of 4.87µg/ear, while intraperitoneal administration presented a moderate activity. The extract did not inhibit phospholipase A2 activity. In the writhing test, the intraperitoneal administration of the extract showed a strong antinociceptive activity (80.2%), while the oral route showed a lower efficacy. In conclusion, this study demonstrated the anti-inflammatory and antinociceptive effects of methanol extract of D. obtusata in experimental models, suggesting its therapeutic potential in the treatment of peripheral painful and/or inflammatory pathologies.

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O objetivo do presente trabalho foi investigar os efeitos antiinflamatórios e antinociceptivos de um extrato metanólico de D. obtusata, utilizando modelos clássicos em ratos (teste do edema de orelha induzido por óleo de cróton e teste de contorções induzidas por ácido acético) e um teste de atividade de fosfolipase A2. A análise qualitativa da composição química das algas foi também determinada através de extração com solventes de polaridade crescente e testes de precipitação e cor. Os resultados do estudo de química qualitativa mostraram a presença de compostos lactônicos e fenólicos, hidratos de carbono reduzidos e outros açúcares, flavonoides, compostos graxos, triterpenos e esteroides. O extrato inibiu o edema de orelha dos ratos de um modo dependente da dose com eficácia superior a 90% e dose média efetiva de 4.87µg/orelha, enquanto a administração intraperitoneal apresentou atividade moderada. O extrato não inibiu a atividade da fosfolipase A2. No teste de contorção, a administração intraperitoneal do extrato mostrou forte atividade antinociceptiva (80,2%), enquanto a administração oral mostrou menor eficácia. Em conclusão, este estudo demonstrou os efeitos antiinflamatórios e antinociceptivos do extrato metanólico de D. obtusata em modelos experimentais, sugerindo seu potencial terapêutico no tratamento de patologias dolorosas periféricas e/ou inflamatórias.

Asunto(s)

Ratones , Analgésicos/clasificación , Antiinflamatorios/clasificación , Rhodophyta , Rhodophyta/clasificación

RESUMEN

BACKGROUND: Half of patients with acute heart failure syndromes (AHFS) have preserved left ventricular ejection fraction (PLVEF). In this setting, the role of minor myocardial damage (MMD), as identified by cardiac troponin T (cTnT), remains to be established. AIM: To evaluate the prevalence and long-term prognostic significance of cTnT elevations in patients with AHFS and PLVEF. PATIENTS AND METHODS: This retrospective, multicenter, collaborative study included 500 patients hospitalized for AHFS with PLVEF (ejection fraction ≥40%) between October 2000 and December 2006. Blood samples were collected within 12 hours after admission and were assayed for cTnT. MMD was defined as a cTnT value of ≥0.020 ng/mL. RESULTS: Mean age was 73 ± 12 years, 47% were female, 38% had an ischemic etiology, and New York Heart Association (NYHA) class was 2.2 ± 0.7. Mean cTnT value was 0.149 ± 0.484 ng/mL, and cTnT was directly correlated with serum creatinine (Spearman's Rho = 0.35, P < .001) and NYHA class (0.25, P < .001). MMD was diagnosed in 220 patients (44%). Patients with MMD showed lower left ventricular ejection fraction (P < .05), higher serum creatinine (P < .001), higher prevalence of ischemic etiology and diabetes mellitus, a worse NYHA class (P < .001), and higher natriuretic peptide levels (P < .001) as compared with patients without MMD. At 6-month follow-up, overall event-free survival was 55% and 75% in patients with and without MMD (P < .001), respectively. On multivariate Cox regression analysis, only NYHA class (HR = 1.50; P = .002) and MMD (HR = 1.81; P = .001) were identified as predictors of events. CONCLUSIONS: Increased cTnT levels were detected in approximately 50% of patients with AHFS with preserved systolic function, and were found to correlate with clinical measures of disease severity. The presence of MMD was associated with a worse long-term outcome, lending support to cTnT-based risk stratification in the setting of AHFS.

Asunto(s)

Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/fisiopatología , Miocardio/metabolismo , Miocardio/patología , Sístole/fisiología , Troponina T/metabolismo , Síndrome Coronario Agudo/epidemiología , Síndrome Coronario Agudo/metabolismo , Síndrome Coronario Agudo/fisiopatología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Argentina/epidemiología , Conducta Cooperativa , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/metabolismo , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Prevalencia , Pronóstico , Estudios Retrospectivos , Síndrome , Tiempo , Troponina T/biosíntesis , Adulto Joven

RESUMEN

Introducción: las plantas medicinales son todas aquellas que contienen un principio activo o más, los cuales, administrados con la dosis adecuada, producen un efecto curativo a las enfermedades del hombre y los animales. El hecho de contener más de un principio activo hace que una planta medicinal pueda servir para tratar diferentes afecciones o trastornos. Objetivo: analizar los beneficios y las potencialidades terapéuticas de la planta marina Thalassia testudinum a partir de una revisión de la información existente y los principales resultados de las investigaciones realizadas sobre este organismo marino. Desarrollo: los productos naturales con propiedades terapéuticas han sido muy utilizados en la medicina tradicional. Indudablemente, los extractos de plantas de origen terrestre han representado hasta el presente una de las fuentes de mayor interés para la obtención de fitofármacos. Sin embargo, una fuente útil aún no explorada lo suficiente son los organismos marinos, que al evolucionar y vivir en condiciones ecológicas únicas y como resultado de su gran diversidad taxonómica en relación con la de los organismos terrestres, pueden sintetizar moléculas que no tienen equivalencia con las encontradas hasta el presente en estos últimos. Eso puede derivar en la obtención de estructuras químicas novedosas con efectos farmacológicos sui generis, tal es el caso de la fenograma marina Thalassia testudinum...(AU)

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Introduction: medicinal plants are those which contain one or more active principles that have a curative effect upon some illnesses which affect men and animals, whenever it is adequately administered. When one plant contains more than one active principle, it can be used to treat different ailments or body disorders. Objective: to analyze the benefits and therapeutic potentialities of the sea plant Thalassia testudinum based on the existent information and in the main results of research works about this sea organism. Development: natural products with therapeutic properties have been widely used in traditional medicine. Undoubtedly, the extracts from ground origin trees have so far represented one of the most interesting sources for phytodrugs. Nevertheless, sea organisms are a useful source which has not been fully explored. As they live and evolve in unique ecologic conditions, and as a result of their great taxonomic diversity in relation to that of ground organisms, they can synthesize molecules that are not equivalent to those of ground organisms found until now. This can derive in obtaining new chemical structures with sui generis pharmacological effects as in the case of the marine phenogram Thalassia testudinum. From this plant, poliphelonic structure-rich extract has been obtained, which show therapeutic potentialities associated to the great variety of beneficial effects that have been described in the studies such as anti-inflammatory, cytoprotective, antioxidative and neuroprotective properties. All the aforementioned turns this new developing product into a possible phytodrug. Conclusions: the sea organisms represent a new source to obtain new phytodrugs and nutritional supplements of great use in human health and nutrition(AU)

Asunto(s)

Hydrocharitaceae , Medicamento Fitoterápico

RESUMEN

Introducción: las plantas medicinales son todas aquellas que contienen un principio activo o más, los cuales, administrados con la dosis adecuada, producen un efecto curativo a las enfermedades del hombre y los animales. El hecho de contener más de un principio activo hace que una planta medicinal pueda servir para tratar diferentes afecciones o trastornos. Objetivo: analizar los beneficios y las potencialidades terapéuticas de la planta marina Thalassia testudinum a partir de una revisión de la información existente y los principales resultados de las investigaciones realizadas sobre este organismo marino. Desarrollo: los productos naturales con propiedades terapéuticas han sido muy utilizados en la medicina tradicional. Indudablemente, los extractos de plantas de origen terrestre han representado hasta el presente una de las fuentes de mayor interés para la obtención de fitofármacos. Sin embargo, una fuente útil aún no explorada lo suficiente son los organismos marinos, que al evolucionar y vivir en condiciones ecológicas únicas y como resultado de su gran diversidad taxonómica en relación con la de los organismos terrestres, pueden sintetizar moléculas que no tienen equivalencia con las encontradas hasta el presente en estos últimos. Eso puede derivar en la obtención de estructuras químicas novedosas con efectos farmacológicos sui generis, tal es el caso de la fenograma marina Thalassia testudinum...

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Introduction: medicinal plants are those which contain one or more active principles that have a curative effect upon some illnesses which affect men and animals, whenever it is adequately administered. When one plant contains more than one active principle, it can be used to treat different ailments or body disorders. Objective: to analyze the benefits and therapeutic potentialities of the sea plant Thalassia testudinum based on the existent information and in the main results of research works about this sea organism. Development: natural products with therapeutic properties have been widely used in traditional medicine. Undoubtedly, the extracts from ground origin trees have so far represented one of the most interesting sources for phytodrugs. Nevertheless, sea organisms are a useful source which has not been fully explored. As they live and evolve in unique ecologic conditions, and as a result of their great taxonomic diversity in relation to that of ground organisms, they can synthesize molecules that are not equivalent to those of ground organisms found until now. This can derive in obtaining new chemical structures with sui generis pharmacological effects as in the case of the marine phenogram Thalassia testudinum. From this plant, poliphelonic structure-rich extract has been obtained, which show therapeutic potentialities associated to the great variety of beneficial effects that have been described in the studies such as anti-inflammatory, cytoprotective, antioxidative and neuroprotective properties. All the aforementioned turns this new developing product into a possible phytodrug. Conclusions: the sea organisms represent a new source to obtain new phytodrugs and nutritional supplements of great use in human health and nutrition

Asunto(s)

Hydrocharitaceae , Medicamento Fitoterápico

RESUMEN

BACKGROUND: Hospital admissions for heart failure are common and readmission rates are high. Many admissions and readmissions may be avoidable, so that alternative strategies are needed to improve long-term management. METHODS: We conducted a randomized trial of the effect of a guideline-based intervention on rates of readmission within 90 days of hospital discharge and costs of care for patients who were hospitalized due to decompensated heart failure. The intervention consisted of comprehensive education of the patient and family, a prescribed diet and intensive application of guidelines' recommendations on pharmacological therapy. The intervention started before discharge and continued thereafter with follow-up visits for up to 3 months. Two hundred and nine guideline-managed patients were compared to 209 concurrent normally-discharged patients. RESULTS: Patients in the study group were more prescribed beta-blockers, ACE-inhibitors, angiotensin receptor blockers, and spironolactone. Sixteen patients (8%) in the intervention group and 31 (15%) among controls were readmitted for DRG 127, within 3 months of discharge (Fisher's exact test, p < 0.01), while the 6-month mortality rate was similar between groups (9 and 11.5% respectively). Quality of life significantly improved from 5.6 +/- 1.0 to 6.1 +/- 1.9 (Mann-Whitney U-test, p < 0.05). The overall costs of care were lower for guideline-managed patients (110 vs 150 Euro per patient per month), due to the lower readmission rates. CONCLUSIONS: Our study showed that a guideline-based management program for patients with heart failure at discharge improves quality of life and reduces readmission for DRG 127 and total bed days, allowing relevant cost savings.

Asunto(s)

Insuficiencia Cardíaca/terapia , Anciano , Femenino , Recursos en Salud/estadística & datos numéricos , Humanos , Masculino , Resultado del Tratamiento

RESUMEN

BACKGROUND: Hospital admissions for heart failure are common and readmission rates are high. Many admissions and readmissions may be avoidable, so that alternative strategies are needed to improve long-term management. METHODS: We conducted a randomized trial of the effect of a guideline-based intervention on rates of readmission within 90 days of hospital discharge and costs of care for patients who were hospitalized due to decompensated heart failure. The intervention consisted of comprehensive education of the patient and family, a prescribed diet and intensive application of guidelines' recommendations on pharmacological therapy. The intervention started before discharge and continued thereafter with follow-up visits for up to 3 months. Two hundred and nine guideline-managed patients were compared to 209 concurrent normally-discharged patients. RESULTS: Patients in the study group were more prescribed beta-blockers, ACE-inhibitors, angiotensin receptor blockers, and spironolactone. Sixteen patients (8%) in the intervention group and 31 (15%) among controls were readmitted for DRG 127, within 3 months of discharge (Fisher's exact test, p < 0.01), while the 6-month mortality rate was similar between groups (9 and 11.5% respectively). Quality of life significantly improved from 5.6 +/- 1.0 to 6.1 +/- 1.9 (Mann-Whitney U-test, p < 0.05). The overall costs of care were lower for guideline-managed patients (110 vs 150 Euro per patient per month), due to the lower readmission rates. CONCLUSIONS: Our study showed that a guideline-based management program for patients with heart failure at discharge improves quality of life and reduces readmission for DRG 127 and total bed days, allowing relevant cost savings.

Asunto(s)

Atención Ambulatoria , Insuficiencia Cardíaca/terapia , Anciano , Protocolos Clínicos , Femenino , Humanos , Italia , Masculino , Alta del Paciente

RESUMEN

BACKGROUND: Heart failure is a common indication for admission to the hospital among old adults. The hospital stay for uncomplicated heart failure is often too long. We hypothesized that a rapid optimization of care and a guideline-based approach would allow an early discharge of patients, still maintaining a greater quality and efficiency of care. METHODS: We conducted a randomized trial of the effect of a guideline-based intervention on rates of readmission within 90 days of hospital discharge and costs of care for patients who were hospitalized for heart failure and discharged after 4 days of stay. The intervention consisted of early echocardiography, aggressive diuretic therapy, comprehensive education of the patient and family, a prescribed diet, and intensive application of the guidelines' recommendations on pharmacological therapy. Fifty early-discharged patients were compared to 50 concurrent normally-discharged patients. RESULTS: Average length of stays during baseline admissions was shorter for early-discharged patients respect to controls (3.9 +/- 0.8 vs 7.0 +/- 1.9 days, p < 0.001). At discharge, when compared with control patients, early-discharged patients were similarly prescribed and/or were taking similar dosages of ACE-inhibitors (84 vs 80% and 17 vs 15 mg/die, p = NS), beta-blockers (64 vs 56% and 14 vs 16 mg/die, p = NS), spironolactone (86 vs 70% and 36 vs 32 mg/die, p = NS), digoxin (74 vs 70% and 0.18 vs 0.15 mg/die, p = NS), and losartan (8 vs 6% and 50 mg/die for both groups, p = NS). Hospital readmission rates and days of stay were similar between groups (6 vs 8% and 18 vs 26 days, respectively for study and control patients), whilst the overall costs of care were lower for early-discharged patients (289 vs 449 [symbol: see text] per patient per month), due to the shorter length of stay at baseline. Survival for 90 days was achieved in 47 patients both in the study and control groups (p = NS). CONCLUSIONS: Our study showed that patients admitted for heart failure may be safely discharged 4 days after admission. An in-hospital guideline-based management of patients allows relevant cost savings, reducing hospital readmission for heart failure.

Asunto(s)

Insuficiencia Cardíaca/economía , Insuficiencia Cardíaca/terapia , Alta del Paciente/economía , Anciano , Protocolos Clínicos , Análisis Costo-Beneficio , Femenino , Humanos , Masculino , Factores de Tiempo

RESUMEN

Se presentó una casuística de 16 pacientes en los cuales se realizó artrodesis del tobillo, se utilizó hidroxiapatita porosa coralina en unión de injerto esponjoso autólogo con el definido objetivo de coadyuvar a la rápida unión ósea en virtud del probado efecto osteoinductivo y osteoconductivo que exibe este bioimplante. Se consiguió la fusión ósea objeto del tratamiento en el 93,7 por ciento de los casos. No se presentaron reacciones adversas ni de rechazo del biomaterial. Se comprobó que la complicación más importante estuvo representada por fracaso de la fusión en un paciente por sepsis posquirúrgica profunda en una extremidad con insuficiencia vascular y diabetes mellitus como enfermedad de base. Se expusieron los resultados y se analizaron en relación con las bondades de este bioimplante como estimulante de la consolidación ósea, así como sus propiedades de no reabsorción, fácil manipulación, esterilización y conservación

Asunto(s)

Artrodesis , Articulación del Tobillo/cirugía , Materiales Biocompatibles

RESUMEN

La estimulación del tejido óseo por medio de corriente eléctrica directa bipolar de 20 microamperes y menos de 1 voltio, asociada a la fijación externa de los huesos, fue utilizada en 29 pacientes con diferentes lesiones óseas. En todos los casos se demostró el papel coadyuvante de la electricidad en la consolidación. Los tiempos en que fue obtenida la curación de las distintas afecciones resultaron inferiores a lo logrado cuando sólo se utilizó la fijación externa en la osteosíntesis interfragmentaria(AU)

Asunto(s)

Callo Óseo , Estimulación Eléctrica , Seudoartrosis/terapia , Fracturas Óseas/terapia , Huesos/lesiones , Fijadores Externos

RESUMEN

Se realizó un estudio de 60 pacientes con el diagnóstico de fractura cerrada de la tibia, atendidos en el Servicio de Ortopedia del Hospital Militar Central "Dr. Carlos J. Finlay" y en el Instituto Superior de Medicina Militar "Dr. Luis Díaz Soto", en el período comprendido entre septiembre de 1991 y febrero de 1994. Se seleccionaron dos grupos (A y B) con 30 pacientes cada uno, a los cuales se les estabilizaron las fracturas mediante fijación externa. Al grupo de estudio a se le administró durante 30 días un ámpula (1 mL) intramuscular de extracto acuoso de sábila (aloe B) a partir de las 24 horas posteriores a la estabilización. El grupo B se tomó como control, pero se le administró 1 mL intranmuscular de solución salina. Se obtuvo una mejoría significativa en el tiempo de consolidación del grupo A con respecto al B, por lo que la reincoración a la vida laboral y social fue más temprana(AU)

Asunto(s)

Humanos , Fracturas Cerradas , Fracturas de la Tibia , Fijadores Externos , Aloe

RESUMEN

Se realizó un estudio de 60 pacientes con el diagnóstico de fractura cerrada de la tibia, atendidos en el Servicio de Ortopedia del Hospital Militar Central "Dr. Carlos J. Finlay" y en el Instituto Superior de Medicina Militar "Dr. Luis Díaz Soto", en el período comprendido entre septiembre de 1991 y febrero de 1994. Se seleccionaron dos grupos (A y B) con 30 pacientes cada uno, a los cuales se les estabilizaron las fracturas mediante fijación externa. Al grupo de estudio a se le administró durante 30 días un ámpula (1 mL) intramuscular de extracto acuoso de sábila (aloe B) a partir de las 24 horas posteriores a la estabilización. El grupo B se tomó como control, pero se le administró 1 mL intranmuscular de solución salina. Se obtuvo una mejoría significativa en el tiempo de consolidación del grupo A con respecto al B, por lo que la reincoración a la vida laboral y social fue más temprana

Asunto(s)

Humanos , Aloe , Fijadores Externos , Fracturas Cerradas , Fracturas de la Tibia

RESUMEN

La estimulación del tejido óseo por medio de corriente eléctrica directa bipolar de 20 microamperes y menos de 1 voltio, asociada a la fijación externa de los huesos, fue utilizada en 29 pacientes con diferentes lesiones óseas. En todos los casos se demostró el papel coadyuvante de la electricidad en la consolidación. Los tiempos en que fue obtenida la curación de las distintas afecciones resultaron inferiores a lo logrado cuando sólo se utilizó la fijación externa en la osteosíntesis interfragmentaria

Asunto(s)

Huesos/lesiones , Callo Óseo , Estimulación Eléctrica , Fijadores Externos , Fracturas Óseas/terapia , Seudoartrosis/terapia

RESUMEN

La estimulación del tejido óseo por medio de corriente eléctrica directa bipolar de 20 microamperes y menos de 1 voltio, asociada a la fijación externa de los huesos, fue utilizada en 29 pacientes con diferentes lesiones óseas. En todos los casos se demostró el papel coadyuvante de la electricidad en la consolidación. Los tiempos en que fue obtenida la curación de las distintas afecciones resultaron inferiores a lo logrado cuando sólo se utilizó la fijación externa en la osteosíntesis interfragmentaria(AU)

Asunto(s)

Humanos , Femenino , Seudoartrosis/terapia , Callo Óseo , Terapia por Estimulación Eléctrica/métodos