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Orientador: Lea Rodrigues Simioni Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas Resumo: Neste trabalho, foi estudada a ação do veneno de Micrurus altirostris (cobra coral Uruguaiana) nas concentrações de 0,1; 0,5; 1; 5 e 10 µg/mL sobre a junção neuromuscular em preparações isoladas de ave (biventer cervicis de pintainho) e de mamífero (nervo frênico-diafragma de camundongo) e também a habilidade do antiveneno comercial produzido pelo Instituto Butantan e do anti-soro específico, produzido em coelhos em neutralizar a neurotoxicidade e a letalidade em pintainhos e camundongos (DL50 0,042 e 0,255 mg/kg), injetados i.m. e i.p., respectivamente, com misturas de veneno (5 DL50): antiveneno ou anti-soro específico (n=6), na razão de 1:1; 1:2,5; 1:5; 1:10 e 1:20. Somente a razão de 1:20 do veneno: antiveneno ou anti-soro neutralizou o bloqueio neuromuscular in vitro e protegeu pintainhos e camundongos contra 5 DL50 do veneno. O veneno causou um completo bloqueio neuromuscular em ambas as preparações, ligando-se aos receptores colinérgicos sub-sinápticos, de maneira irreversível. Inibiu as contraturas causadas por ação da acetilcolina e do carbacol, sem interferir nas respostas ao KCl. O bloqueio neuromuscular causado pelo veneno não apresentou qualquer alteração na ausência de íons Ca2+ ou com a diminuição da temperatura, tampouco foi revertido por ação da neostigmina. A resposta ao estímulo direto não foi afetada na vigência do bloqueio neuromuscular completo, indicando pela perfeita resposta muscular, que a membrana manteve-se íntegra, o que sugere a ausência de uma atividade miotóxica. Os resultados indicaram que o veneno de Micrurus altirostris interfere com a neurotransmissão pós-sináptica e que o antiveneno comercial, bem como o anti-soro específico, produzido em coelhos, possuem baixa eficácia em neutralizar a neurotoxicidade e a letalidade deste veneno. A neutralização da ação neurotóxica e também da letalidade do veneno foi obtida apenas quando a proporção de 1:20 (veneno:antiveneno) foi utilizada Abstract: In this work, we studied the neuromuscular blockade caused by Micrurus altirostris venom (0.1-10 µg/mL) in indirect stimulated chick biventer cervicis and mouse phrenic nerve-diaphragm preparations and the ability of commercial antivenom (Instituto Butantan) and antiserum raised in rabbits to neutralize neurotoxicity and lethality in chicks and mice (LD50 0.042 and 0.255 mg/kg), injected i.m. and i.p., respectively, with venom (5 LD50):antivenom or antiserum mixtures (n=6) of 1:1, 1:2.5, 1:5, 1:10 and 1:20. The venom caused a complete and irreversible neuromuscular blockade in both preparations, binding in the subsynaptics colynergic receptors; inhibited the acetylcholine and carbachol contractures, without interfering on KCl response. The neuromuscular blockade was not Ca2+ or temperature-dependent and did not affect the response to direct stimulation. Only a venom:antivenom or antiserum ratio of 1:20 neutralized the neuromuscular blockade in vitro and protected chicks and mice against 5 LD50 of venom. Our results indicated that Micrurus altirostris venom interferes with postsynaptic neurotransmission and that commercial antivenom and rabbit antiserum have low efficacy in neutralizing the neurotoxicity and lethality of this venom Doutorado Doutor em Farmacologia

BACKGROUND AND OBJECTIVES: This randomized trial aimed to assess if a combined suprascapular-axillary nerve block (SSB) is noninferior (margin = 1.3 on a 0- to 10-point scale) to interscalene block (ISB) in treating pain after arthroscopic shoulder surgery. Secondary end points included opioid consumption, dyspnea, discomfort associated with muscle weakness, and patient satisfaction. METHODS: One hundred patients undergoing arthroscopic shoulder surgery were randomized to receive ultrasound-guided ISB (n = 50) or SSB (n = 50). Pain intensity at rest, dyspnea, and discomfort were recorded upon arrival in the recovery room, discharge to the ward, and at 4, 8, and 24 hours after surgery. Piritramide consumption was recorded for the first 24 hours. Patient satisfaction was assessed on the second postoperative day. RESULTS: During the first 4 hours after surgery, the difference in mean pain score between SSB and ISB was higher than 2.5 (±0.8). The difference gradually decreased to 1.1 (±1.0) at 8 hours before resulting in noninferiority during the night and at 24 hours. Piritramide consumption was significantly higher in the SSB group in the first 8 hours. The incidence of dyspnea and discomfort was higher after ISB. Treatment satisfaction was similar in both groups. CONCLUSIONS: Suprascapular-axillary nerve block is inferior to ISB in terms of analgesia and opioid requirement in the immediate period after arthroscopic shoulder surgery but is associated with a lower incidence of dyspnea and discomfort. The difference in pain and opioid consumption gradually decreases as the blocks wear off in order to reach similar pain scores during the first postoperative night and at 24 hours. CLINICAL TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov, identifier NCT02415088. ispartof: REGIONAL ANESTHESIA AND PAIN MEDICINE vol:43 issue:7 pages:738-744 ispartof: location:England status: published

Rationale: Biomarkers for survival in amyotrophic lateral sclerosis (ALS) would facilitate the development of novel drugs. Although respiratory muscle weakness is a known predictor of poor prognosis, a comprehensive comparison of different tests is lacking. Objectives: To compare the predictive power of invasive and noninvasive respiratory muscle strength assessments for survival or ventilator-free survival, up to 3 years. Methods: From a previously published report respiratory muscle strength measurements were available for 78 patients with ALS. Time to death and/or ventilation were ascertained. Receiver operating characteristic analysis was used to determine the cutoff point of each parameter. Measurements and Main Results: Each respiratory muscle strength assessment individually achieved statistical significance for prediction of survival or ventilator-free survival. In multivariate analysis sniff trans-diaphragmatic and esophageal pressure, twitch trans-diaphragmatic pressure (Tw Pdi), age, and maximal static expiratory mouth pressure were significant predictors of ventilationfree survival and Tw Pdi and maximal static expiratory mouth pressure for absolute survival. Although all measures had good specificity, there were differing sensitivities. All cutoff points for the VC were greater than 80% of normal, except for prediction of 3-month outcomes. Sequential data showed a linear decline for direct measures of respiratory muscle strength, whereas VC showed little to no decline until 12 months before death/ventilation. Conclusions: The most powerful biomarker for mortality stratification was Tw Pdi, but the predictive power of sniff nasal inspiratory pressure was also excellent. A VC within normal range suggested a good prognosis at 3 months but was of little other value.