Aliskiren is an oral antihypertensive medication that acts by directly inhibiting renin. High levels of circulating renin and prorenin activate the pathological signaling pathway of fibrosis. This drug also reduces oxidative stress. Thus, the aim of this systematic review is to analyze experimental studies that show the actions of aliskiren on fibrosis. PubMed and LILACS databases were consulted using the keywords aliskiren and fibrosis within the period between 2005 and 2017. Fifty‐three articles were analyzed. In the heart, aliskiren attenuated remodeling, hypertrophy, inflammatory cytokines, collagen deposition, and oxidative stress. In the kidneys, there was a reduction in interstitial fibrosis, the infiltration of inflammatory cells, apoptosis, proteinuria, and in the recruitment of macrophages. In diabetic models, an improvement in the albumin/creatinine relationship and in the insulin pathway in skeletal muscles was observed; aliskiren was beneficial to pancreatic function and glucose tolerance. In the liver, aliskiren reduced fibrosis, steatosis, inflammatory cytokines, and collagen deposition. In the lung and peritoneal tissues, there was a reduction in fibrosis. Many studies have reported on the beneficial effects of aliskiren on endothelial function and arterial rigidity. A reduction in fibrosis in different organs is cited by many authors, which complies with the results found in this review. However, studies diverge on the use of the drug in diabetic patients. Aliskiren has antifibrotic potential in several experimental models, interfering with the levels of fibrogenic cytokines and oxidative stress. Therefore, its use in diseases in which fibrosis plays an important pathophysiological role is suggested.
Introduction: Dyspepsia refers to a set of gastro duodenal symptoms, four of which are major: postprandial fullness, early satiety, epigastric pain and burning. There are disadvantages in the requests for immediate endoscopies for all patients with dyspeptic symptoms. The high prevalence of dyspepsia in the population means that the request for endoscopy for all would reflect a high cost and would burden the services. The indiscriminate application of endoscopies does not promote benefit.Objective: To know if the endoscopy was well addressed in our Endoscopy Center _Santo André knowing the correlation between dyspeptic syndrome and endoscopic findings.Methods: Cross-sectional study was conducted at the Digestive Endoscopy Service of the ABC Medical School. In the waiting room of endoscopy service 102 patients already addressed to endoscopy exam, agreed to fulfill a questionnaire in which demographic data and symptoms with their main characteristics were collected. The researchers did not indicate the exam requests. Consecutive, selected participants aged 15 to 60 years who are diagnosed with dyspepsia and were indicated to perform upper digestive endoscopy were included and the endoscopy findings were computed. Results:The main complaint was heartburn (31.3%), related to food (56%). Among the alarm signals, the most observed was weight loss (35%), duration of symptoms greater than 6months (72.5%), high frequency during the week (38%). 59% of patients were taking proton pump inhibitor -Omeprazole and we verified that 60% of patients had no need for endoscopy and 84.8% had functional dyspepsia. Among the patients who tested for Helicobacter pylori, 38.15% had a positive result.Discussion: Most of the indications were not judicious, which implies considerable damage to the public coffers, especially in a country with scarce resources like Brazil. Conclusion:In our region, there are indiscriminate indications of endoscopies, which cause unnecessary expenses, requiring the approval of a new guideline for developing countries, in order to optimize spending and waiting line.
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