Investigación Clínica

Tabla de Contenido

Elena Ryder — 2025-03-06

Modernización del uso de la clozapina en Venezuela.

Trino Baptista — 2025-03-06

Until few years ago, clozapine (CLZ) was scarcely used in psychiatric patients in Venezuela, even when it was an effective antipsychotic drug in severe mental disorders. This was mainly due to the severe adverse effects (AEs) sometimes occurring during CLZ treatment, and unpredictable drug availability. Even though Venezuela leads South American countries in the number of high-quality published studies about the drug’s AEs, local clinicians are still reluctant to its use. Recent knowledge in CLZ pharmacokinetics allows a safer administration. Our research group has promoted an education program about CLZ use in Venezuela, but few colleagues’ have answered our request. We hope this Editorial will improve this attitude, which may lead to improving life quality in psychiatric and neurological patients with severe disorders.

Phillygenin reduced neuropathic pain by inhibiting the rats’ TLR4/MyD88/NF-κB pathway.

Lei Hua — 2025-03-06

To elucidate the effects of phillygenin (PHI) and the potential mechanism on TLR4 and MyD88/NF-κB signalling in neuropathic pain in animal studies, chronic constriction injury (CCI) models were constructed for neuropathic pain induction using male Sprague-Dawley rats. PHI (20 mg/kg) was delivered through intragastric administration. Von Frey and Hargreaves tests were implemented to determine the 50% paw-withdrawal threshold (PWT) and paw-withdrawal latency (PWL). A nitric oxide (NO) assay was used for NO level detection, and an ELISA assay was employed to measure the expression of proinflammatory cytokines. Western blotting and RT-qPCR were conducted for protein and mRNA level detection. Treatment with PHI significantly enhanced 50% of PWT and PWL. PHI significantly decreased the levels of NO and reduced the levels of TNF-α, IL-1β, and IL-6. PHI also downregulated TLR4 and MyD88 expressions and inhibited the phosphorylation of NF-κB. PHI ameliorated inflammatory status and alleviated neuropathic pain in CCI rats, targeting TLR4 and suppressing MyD88/NF-κB signalling.

Values of hemodynamic changes of fetal vessels evaluated by color Doppler ultrasound for fetuses with growth restriction.

Yangyang Chen — 2025-03-06

We aimed to explore the values of hemodynamic changes of fetal vessels evaluated by color Doppler ultrasound (CDUS) for fetal growth restriction (FGR). A retrospective analysis was performed on clinical data of 75 pregnant women who received prenatal examination from January 2021 to August 2023 and whose fetuses were diagnosed with FGR (FGR group) and 75 pregnant women whose fetuses were healthy in the same period and were considered as the healthy group. CDUS was performed on the fetuses. The values of indicators of umbilical artery, middle cerebral artery and aortic arch isthmus for assessing pregnancy outcomes were investigated. The FGR group had significantly lowered arterial resistance index (RI), blood flow pulsatility index (PI), and systolic and diastolic velocity (S/D) levels of the middle cerebral artery and peak systolic velocity (PSV)/end-systolic reflux velocity (ESRV) level of aortic arch isthmus but significantly elevated RI, PI, and S/D levels of umbilical artery in comparison with those of the healthy group (p<0.05). The areas under the receiver operating characteristic curves (AUCs) of RI, PI, and S/D of the umbilical artery in diagnosing FGR were 0.893, 0.893 and 0.900, respectively, AUCs of RI, PI, and S/D of the middle cerebral artery were 0.812, 0.874 and 0.910, respectively, and AUC of PSV/ESRV was 0.857 (p<0.05). The incidence rate of severe hypoxia was significantly higher in the fetuses with a more significant RI value of the middle cerebral artery and a larger PSV/ESRV value than those with a smaller RI value of the middle cerebral artery and a smaller PSV/ESRV value (p<0.05). The changes in umbilical artery RI, middle cerebral artery RI, and PSV/ESRV were unrelated to fetal survival rate (p>0.05). Fetal umbilical artery, middle cerebral artery and aortic arch isthmus parameters detected through CDUS are all sensitive indices for assessing FGR.

Pesquisa y diagnóstico de trastorno depresivo en una comunidad rural de Venezuela.

Jessica Leyva — 2025-03-06

The COVID-19 pandemic has triggered a global increase in the incidence of psychological consultations related to anxiety and depressive disorder, which, together with the humanitarian crisis in Venezuela, produced a surge in reported cases of these pathologies nationwide. Currently, there are no works available that document the prevalence of depressive disorder in rural communities in Venezuela. This work aimed to determine the prevalence of depressive disorder in La Marroquina, a rural community in Yaracuy State, Venezuela, through a cross-sectional study conducted in July 2022, with an estimated population of 611 patients and a sample of 160. The study included two phases: a brief interview, where the Patient Health Questionnaire 9 (PHQ-9) was conducted and in a second phase, an interview with a Psychiatry specialist who used the Hamilton Depression Scale (HAM-D) for the diagnosis of depression. In the psychiatric triage for depression, 67 patients obtained PHQ-9 scores >10 points, of which only 39 attended a consultation. When performing the psychiatric evaluation of these patients, the depressive disorder was diagnosed in 30 patients, with a prevalence in the community of La Marroquina of 18.75%. A statistically significant association was found between the risk of depression according to the PHQ-9 and unemployment. The fact that the scales do not allow differentiating between different types of depressive disorder, as well as the social stigma of attending a psychiatric consultation, may cause underreporting in our study. La Marroquina has a high prevalence of depressive disorder, which is related to unemployment as the most important risk factor.

Clinical impact of early enteral nutrition on postoperative pain, gastrointestinal function and nutritional status in colorectal cancer patients.

Yue Qin — 2025-03-06

This research aimed to clarify the clinical impact of early enteral nutrition (EN) on postoperative pain, gastrointestinal function and nutritional status of colorectal cancer (CRC) patients. Eighty rectal cancer patients undergoing surgery in our hospital from October 2021 to October 2023 were selected as research subjects and divided into an experimental group (EG) and a control group (CG) using a random number table method, with 40 cases each. Both groups received conventional nursing, including preoperative, intraoperative, and postoperative nursing. The CG received a traditional preoperative routine diet and postoperative EN support. The EG received five-day preoperative EN support and postoperative parenteral nutrition support based on a traditional preoperative routine diet. The analgesic effect indicators, pain scores, gastrointestinal function recovery indicators, adverse reactions and nutritional indicators in both groups received measurement and comparison. The Average additional amount of flurbiprofen axetil in the EG decreased relative to those in the CG (p<0.05). At six h and 12 h after surgery, VAS scores in the EG were lower than those in the CG during the same period; at 24 h and 48 h after surgery, no statistical significance in VAS scores was shown between both groups (p>0.05). The bowel sound recovery time, first defecating time, first exhaust time, and first getting-out- of-bed time in EG were inferior relative to those in the CG (p<0.05). The incidence of adverse reactions in the EG was reduced relative to that in the CG (p<0.05). Before surgery and one day after surgery, no statistically significant differences in total protein (TP) and serum albumin (ALB) levels were shown between both groups (p>0.05); three days and seven days after surgery, TP and ALB levels in the EG exhibited an elevation relative to those in CG during the same period (p<0.05). In conclusion, early EN can improve not only postoperative gastrointestinal function and nutritional status of patients but also mitigate postoperative pain and facilitate postoperative recovery with high safety, which is worthy of further clinical promotion.

Health profile of patients subjected to gastric bypass at Clinics Hospital of Acre, Brazil.

Suellem Maria Bezerra de Moura Rocha — 2025-03-06

The study aimed to analyze the health profile of women undergoing Roux-en-Y gastric bypass according to the time elapsed since surgery. Ninety-three women who underwent this procedure at the Clinics Hospital in Acre, Brazil, from 2008-2017, were divided into three groups according to the post-surgery period: G1 (n = 37) up to two years; G2 (n = 20) from two to four years; G3 over four years (n = 36) after surgery. Pre-surgery and post- surgery clinical, anthropometric, and dietary variables were analyzed through a 24-hour recall. The postoperative time was 16.9±7.9 months (G1); 33.9±9.2 months (G2) and 75.3±19.1 months (G3). In the postoperative period, there was a decrease in the number of patients who practiced physical activity (35.5-33.3%). The mean percentage of excess weight loss was 66.1±15.4%. Satisfactory results were achieved by 88.17% (% PEP ≥50%). 67% of the patients presented weight reacquisition, proportional to the postoperative time (p˂0.001). The dietary survey indicated a daily energy consumption of 1262.75±424.11 kcal. The macronutrient distribution showed 59.25±8.33% for carbohydrates, 24.26±6, 90% for lipids and 17.12±6.68% for proteins. The mean protein intake was lower in group G1 (16.09±6.23), and lipid intake slightly increased over time. Bariatric surgery had a significant impact on the reduction of comorbidities, medication use, and the loss of excess weight. However, the nutrient adequacy and the increasing incidence of weight regain in the post- surgery period demonstrated that bariatric surgery does not end the obesity treatment, but it is only a step that requires periodic monitoring.

Phyllanthin from Phyllanthus amarus protects the myocardium during pressure overload-induced cardiac hypertrophy by inhibiting the angiotensin-converting enzyme.

Changyou Zhu — 2025-03-06

Ischemic heart disease results from obstruction of blood flow and leads to myocardial infarction. Various lignans of herbal origin have been shown to protect against cardiotoxicity. The present study aimed to assess the potential of phyllanthin, identified from a standardized methanolic extract of Phyllanthus amarus (PAME), against pressure overload-induced cardiac hypertrophy in experimental rats. Lignan was identified in PAME using HPLC. Ligating the abdominal aorta induced cardiac hypertrophy in Wistar rats (220-240g). Then they were treated with (n=15, each) either distilled water (10 mL/kg, aortic stenosis control), lisinopril (15 mg/kg), or PAME (50, 100 and 200 mg/kg) for 28 days. Lignan compounds were identified using UV spectra in PAME, and HPLC analysis showed the presence of phyllanthin at 25.30 retention time with an area of 70.22%. Treatment with PAME (100 and 200 mg/kg) significantly and dose-dependently (p<0.01 and p<0.001) ameliorated AS- induced elevation in absolute and relative heart weights, increased serum biomarker levels, and alterations in electrocardiographic and hemodynamic functions. PAME effectively inhibited AS-induced oxide-nitrosative stress dose-dependently (p<0.01 and p<0.001). Up-regulated mRNA expression of cardiac angiotensin- converting enzyme (ACE) andCollagen-I were also markedly inhibited (p<0.01 and p<0.001) by PAME. Furthermore, PAME significantly reduced (p<0.01 and p<0.001) pressure overload-induced alterations in cardiac histopathology. In conclusion, phyllanthin identified from P. amarus ameliorated pressure overload-induced cardiac hypertrophy by inhibiting ACE and collagen-I formation pathways to alleviate hypertension and fibrosis. These findings collectively suggest that P. amarus represents promising therapy for managing ischemic heart diseases.

The role of 5-fluorouracil in Wnt/β-catenin signalling in human papillomavirus-positive cervical cancer cells.

Lifang Wen — 2025-03-06

Human papillomavirus (HPV) infection is a major risk factor for cervical cancer, especially persistent infection with high-risk HPV. 5-fluorouracil (5-FU) is a widely used antimetabolite chemotherapeutic agent that inhibits the proliferation of tumour cells by interfering with ribonucleic acid and deoxyribonucleic acid synthesis; however, its mechanism of action has not been fully elucidated. This study aimed to investigate the role of Wnt/ β-catenin signalling in patients with high-risk HPV with cervical cancer treated with 5-FU. Patients with high-risk HPV-positive cervical cancer treated with surgery were taken as the research participants, and lesion tissues were collected during surgery. Human HPV-positive cervical cancer cells were isolated and cultured in vitro by the enzyme combined digestion method, and the obtained cells were divided into a control group, a paclitaxel group and a 5-FU group. A 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) assay was used to measure the proliferation of high-risk HPV-positive cervical cancer cells under different treatment conditions. Western blotting was used to evaluate the protein expression level of the Wnt/β-catenin signalling pathway in cells, and flow cytometry was used to analyse the level of T lymphocytes in the patients’ blood. The results of the MTT assay showed that the proliferation rate of cervical cancer cells in the control group was significantly higher than that in the paclitaxel group and the 5-FU group at all detection time points (p<0.05). The expression levels of Wnt/β- catenin protein in the 5-FU group were lower than those in the paclitaxel and the control groups (p<0.05). The results of the T lymphocyte level comparison showed that the ratios of CD3+ T cells, CD4+ T cells and CD4+ /CD8+ cells affected by 5-FU were higher than those before treatment (p<0.05). 5-fluorouracil can significantly reduce the expression level of Wnt/β-catenin protein and increase the T lymphocyte levels in cervical cancer cells.

Effect of early enteral nutrition on postoperative outcomes in pancreatic cancer patients with diabetes.

Xinjie Wang — 2025-03-06

This study aimed to evaluate the impact of early enteral nutrition support in pancreatic cancer patients with diabetes mellitus following total pancreatectomy. Ninety-six patients were randomly divided into control and research groups, each with 48 patients. Both groups received parenteral nutrition, while the research group received additional enteral nutrition within the first 48 hours post-surgery. Results showed that the research group experienced faster recovery of bowel sounds, earlier first defecation, and shorter gastric tube retention times compared to the control group (p<0.05). Postoperative gastrointestinal function, immune function, and nutritional status were significantly better in the research group, with higher levels of gastrin, motilin, immunoglobulins G, A, and M, CD4/CD8 ratio, albumin, prealbumin, and transferrin (p<0.05). Furthermore, the research group had better blood glucose control from 48 hours to seven days post-surgery (p<0.05). The above results demonstrated a promoting impact of early nutrition support on postoperative physical functioning recovery of pancreatic cancer patients with diabetes mellitus. In conclusion, early enteral nutrition support in pancreatic cancer patients with diabetes mellitus significantly improved nutritional status, postoperative gastrointestinal recovery, gastrointestinal and immune function, and blood glucose control, leading to a better overall prognosis.

Hiperplasia endometrial: una revisión narrativa sobre su patogénesis, factores de riesgo y diagnóstico.

José Núñez-Troconis — 2025-03-06

Endometrial hyperplasia with or without atypia is a common gynecological diagnosis and serve as precursor to endometrial carcinoma. During the reproductive years, the risk of developing endometrial hyperplasia is related to ovulatory disorders. In menopause and postmenopause, endometrial hyperplasia is linked to factors such as obesity, estrogen replacement therapy, and others. This narrative study aims to review and analyze the pathogenesis, risk factors, and different diagnostic methods related to endometrial hyperplasia. The literature from 1970 and November 2024 was reviewed in the Latin American and international bibliography using electronic databases such as Pub-Med, Google Scholar, Springer, the Cochrane Library, Embase, Scielo, Imbiomed-L, Redalyc, and Latindex, among others.

Instrucciones a los Autores

Elena Ryder — 2025-03-06

Author Instructions

2025-03-06