Most episodes of short-term symptomatic hypoglycemia are effectively treated by the ingestion of carbohydrates 1) or glucagon injection.2) However, in spite the fact that glucose and glucagon are very effective to treat short term insulin-induced hypoglycemia (IIH), both antidotes show transitory effect 1,2) and for this reason they are not effective to prevent prolonged IIH. Moreover, patients who receive insulin therapy frequently experience prolonged IIH, particularly nocturnal hypoglycemia that represents 55-75% of severe episodes of IIH. 3)Therefore, for episodes of prolonged IIH during sleep, when the subject is unable to self-treat, new strategies to prevent IIH are necessary. 4) However, there are few studies in the prevention of nocturnal hypoglycemia. 5,6) Because rats show a suitable experimental model to study hypoglycemia [7][8][9][10] and considering the night habits of these animals, nocturnal IIH can be simulated with a diurnal pharmacological dose of Detemir insulin. Moreover, in spite the fact that glutamine dipeptide has been shown effective to promote acute glycemia recovery during long term IIH, 11) its rule to prevent prolonged hypoglycemia was not investigated. Thus, by using this rat model [7][8][9][10][11] we investigated if L-alanyl-L-glutamine peptide (glutamine dipeptide) could help against prolonged IIH. The choice of glutamine dipeptide was based in the following facts: 1) glutamine dipeptide results of the combination of the most abundant blood amino acid, i.e., L-glutamine 12) and the most important liver glucose precursor, i.e., L-alanine, 13) 2) very high doses of oral glutamine dipeptide did not show acute or subchronic toxicity, 14) 3) glutamine dipeptide overcomes the intestinal catabolism of Lglutamine, 15) 4) L-alanine from glutamine dipeptide catabolism stimulates the release of glucagon. 16,17) In addition the contribution of the liver gluconeogenesis from glutamine dipeptide and their metabolites L-alanine and L-glutamine to prevent prolonged hypoglycemia were investigated. Animals Adult male Wistar rats (180-220 g) were maintained on food and water ad libitum before the initiation of experimental procedures. The manipulation of the animals was approved by the ethical committee of the State University of Maringá, PR, Brazil (approval number 042/2006). On the day before the experiment the animals were food deprived from 5:00 p.m. All experiments were performed with overnight fasted rats (5:00 p.m.-9:00 a.m.). MATERIALS AND METHODS MaterialsExperimental Prolonged IIH A preliminary experiment to characterize the prolonged IIH after an intraperitoneal (i.p.) injection of Detemir insulin (1.0 U/kg) was done. Detemir insulin was not diluted but intraperitoneally injected (9:00 a.m.) with help of an infusion pump (Insight The role of glutamine dipeptide (GDP) to prevent against prolonged insulin induced hypoglycemia (IIH) in overnight fasted rats was investigated. The glycemia was measured 0, 2, 4, 8, and 10 h after an intraperitoneal (i.p.) injection (1 U/kg) of Detemir in...
We previously demonstrated an increased liver gluconeogenesis (LG) during insulin-induced hypoglycaemia. Thus, an expected effect of sulphonylureas induced hypoglycaemia (SIH) could be the activation of LG. However, sulphonylureas infused directly in to the liver inhibits LG. Considering these opposite effects we investigated herein LG in rats submitted to SIH. For this purpose, 24 h fasted rats that received glibenclamide (10 mg kg(-1) ) were used (SIH group). Control group received oral saline. Glycaemia at 30, 60, 90, 120 and 150 min after oral administration of glibenclamide were evaluated. Since the lowest glycaemia was obtained 120 min after glibenclamide administration, this time was chosen to investigate LG in situ perfused livers. The gluconeogenesis from precursors that enters in this metabolic pathway before the mitochondrial step, i.e. L-alanine (5 mM), L-lactate (2 mM), pyruvate (5 mM) and L-glutamine were decreased (p < 0·05). However, the gluconeogenic activity using glycerol (2 mM), which enters in the gluconeogenesis after the mitochondrial step was maintained. Taken together, the results suggest that the inhibition of LG promoted by SIH overcome the activation of this metabolic pathway promoted by IIH and could be attributed, at least in part, to its effect on mitochondrial function.
The influence of sodium nitroprusside (SNP) induced hypotension on the extra-cellular tumour pH during local hyperthermia (HT), and on the cytotoxic effect of HT, was studied in the BT4An tumour transplanted to the hind limb of BD IX rats. Experiments with intravenous infusion of glucose before the HT/SNP combination were also performed. Local waterbath HT was given at 44 degrees C. Sodium nitroprusside was administered as a continuous i.v. infusion to lower the mean arterial blood pressure to 60 mmHg. Glucose was given as an i.v. infusion at a dosage of 4.8 g/kg body weight in 60 min before HT. Extracellular tumour pH was measured by a needle type glass electrode. The tumour pH fell from 7.19 to 6.81, on average, after 60 min HT. Sodium nitroprusside induced hypotension during HT did not increase the pH fall after 1 h HT, but the pH 60 min after discontinuation of HT was lower in this group than in the HT alone group. Pretreatment with glucose before HT gave similar results as the HT/SNP combination. When glucose was given before HT/SNP a highly relevant decline in tumour pH during HT from 7.22 to 5.95 was observed. In a separate tumour response experiment adding SNP to HT was found to prolong the tumour growth time. Pre-treatment with glucose before the HT/SNP combination prolonged the tumour growth time slightly. The applicability of this treatment protocol in the clinical treatment of patients is discussed.
Objetivo: Examinar e mapear as evidências científicas sobre o manejo clínico em pacientes sépticos em UTI covid-19. Métodos: Scoping Review, baseado nos procedimentos recomendados pelo Instituto Joanna Briggs. Estabeleceu-se a pergunta norteadora: “Quais são as evidências científicas sobre o manejo clínico de enfermagem em pacientes com sepse na UTI covid?”. Foram realizadas buscas nas seguintes bases de dados: Scielo, PubMed, Lilacs e Portal da Capes, sobre trabalhos publicados até agosto de 2022. Dos 118 estudos encontrados, 06 foram selecionados para leitura na íntegra, resultando em uma amostra final de 05 estudos analisados. Resultados: As cinco publicações analisadas foram publicadas no ano de 2021. Os estudos selecionados sobre a temática são de âmbito nacional e internacional e de abordagens quantitativa, qualitativa e qualiquantitativa. Os objetos dos estudos foram semelhantes, uma vez que a maioria retratava sobre cuidados de enfermagem em pacientes sépticos acometidos pela covid-19. Conclusões: Os resultados desta revisão mostraram uma escassez de estudos nacionais e internacionais sobre a identificação precoce e manejo clínico do paciente séptico acometido pela covid-19. A relevância do tema e sua complexidade evidenciam a necessidade de pesquisas sobre o assunto.
Sendo a epidermólise bolhosa uma doença de classificação rara, poucos estudos são direcionados a esta doença e a falta de instrução aos profissionais de enfermagem acaba sendo uma prática comum; o que prejudica o diagnostico precoce e compromete o atendimento adequado ao paciente desta condição. Isso porque a assistência adequada deve ser prestada aos portadores de epidermólise bolhosa de modo emergencial e precoce, afim de minimizar traumas, atritos, pressão, e agravamento das feridas características dessas doenças. Objetivo: Investigar na literatura cientifica os cuidados de enfermagem necessários para uma assistência de enfermagem adequada a pacientes com Epidermólise Bolhosa. Método: Trata-se de um estudo bibliográfico de caráter exploratório, que de modo qualitativo procura estudar a respeito da Epidermólise Bolhosa os cuidados específicos que devem ser atribuídos aos profissionais de enfermagem no tratamento desta condição. Resultados: Através da pesquisa realizada, pode-se constatar que o atendimento personalizado ao paciente com epidermólise bolhosa, não apenas reduz os riscos de agravamento e complicações da doença, como possibilita que os indivíduos, ainda que com essas anomalias, tenham sua qualidade de vida melhorada através dos cuidados e do tratamento especializado. Conclusão: Ao profissional de enfermagem, o estudo sobre o tratamento da epidermólise e as implicações técnicas adequadas para esta condição é algo indispensável e necessário para assegurar a eficiência no tratamento nos pacientes desta condição.
O objetivo deste estudo é identificar as ações de enfermeiros no momento intraparto para prevenção da violência obstétrica. Esta pesquisa foi um estudo qualitativo e descritivo na modalidade revisão integrativa de literatura. A amostra foi composta por artigos científicos disponibilizados nos bancos de dados virtuais relevantes da área, como SCIELO, BVS, LILACS, BDENF e outros. Os critérios de inclusão estabelecidos foram: artigos publicados na íntegra, disponibilizados online sem período de tempo, escritos em português. Foram excluídos materiais considerados literatura cinzenta. Para a busca do material nas bases de dados, utilizou-se os Descritores em Ciências da Saúde (DeCS) “Enfermagem”, “Violência Obstétrica” e “Trabalho de Parto”com o operador booleano “and” e “or”. Ao final, foram selecionados 07 (sete) artigos que se encaixavam no objetivo proposto deste estudo. A violência obstétrica induz a parturiente a sentir o que é a chamada dor do parto desumanizado trazendo para a mesmo impactose/ouimplicações sobre a sua saúde. Neste sentido, o objetivo do estudo é identificar asações de enfermeiros no momento intraparto para prevenção da violência obstétrica.Vale salientar que as novas tecnologias do mundo contemporâneo, juntamente com a medicalização, tornaram o momento do parto, um ato hospitalar, levando o médico a se tornar o protagonista de tal feito e o processo como patológico, de modo que o profissional vem se apoderando da responsabilidade e da autonomia durante o processo parturitivo.
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