RESUMO
UNLABELLED: Review of the 1-year prevalence of screening for osteoporosis and of osteoporosis or idiopathic fracture in Maryland Medicaid administrative records found that screening rates did not differ among women in the control population, women with psychosis, and women with major mood disorders, but were reduced compared to controls in women with substance use disorder, with or without psychosis. Prevalence of osteoporosis was increased compared to controls in women with major mood disorders or women over 55 dually diagnosed with psychosis and substance use disorder. INTRODUCTION: Osteoporosis is a major public health concern. Substance abuse and psychosis may be risk factors, however, frequency of screening and disease risk in women with psychotic disorders and substance use disorder (SUD) remains unknown. METHODS: This study examined rates (FY 2005) of osteoporosis screening and disease risk in Medicaid enrolled women aged 50 to 64 (N = 18,953). Four diagnostic groups were characterized: (1) psychosis, (2) SUD, (3) major mood disorder, and (4) controls. The interaction of psychosis and SUD on screening and disease prevalence of osteoporosis was tested. RESULTS: The prevalence of osteoporosis across the entire population was 6.7%. Four percent of those without an osteoporosis diagnosis received osteoporosis screening with no notable differences between psychosis and controls. Those with SUD, however, had a significant reduction in screening compared to controls (OR = 0.61, 95% CI = 0.40-0.91, p = 0.016). Women with a major mood disorder were more likely to have osteoporosis in their administrative record (OR = 1.32, 95% CI = 1.03-1.70, p = 0.028) compared to controls. Those who were dually diagnosed (SUD and psychosis) in the oldest ages (55-64 years) had a markedly higher prevalence of osteoporosis compared to controls (OR = 6.4 CI = 1.51-27.6, p = 0.012), whereas this interaction (SUD and psychosis) was not significant in the entire population over age 49. CONCLUSIONS: Osteoporosis screening in the Medicaid population is significantly lower for women with SUD, after adjusting for age, race, and Medicaid enrollment category. The prevalence of osteoporosis appears markedly elevated in those with major mood disorders and those over age 55 dually diagnosed with schizophrenia and SUD.
Assuntos
Programas de Rastreamento/estatística & dados numéricos , Osteoporose Pós-Menopausa/etiologia , Transtornos Psicóticos/complicações , Transtornos Relacionados ao Uso de Substâncias/complicações , Fatores Etários , Diagnóstico Duplo (Psiquiatria) , Métodos Epidemiológicos , Feminino , Humanos , Maryland/epidemiologia , Medicaid , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/diagnóstico , Osteoporose Pós-Menopausa/epidemiologia , Transtornos Psicóticos/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados UnidosRESUMO
BACKGROUND: The purpose of this study was to verify which muscle among the adductor pollicis (AP), orbicularis oculi (OO), and corrugator supercilii (CS) is a better predictor of optimal intubating conditions after administration of rocuronium. METHODS: In this prospective trial, 201 patients were randomized into six groups to receive rocuronium at a dose of 0.6 or 1.0 mg kg(-1) during propofol-remifentanil-nitrous oxide anaesthesia. The tracheal intubation was performed after maximal neuromuscular block by acceleromyography at the thumb (AP), the eyelid (OO), and the superciliary arch (CS). The onset time, intubating conditions, peak vital signs, and bispectral index were assessed. RESULTS: The onset time of rocuronium in the OO and CS muscle was significantly shorter than in the AP muscle (P<0.001), but excellent intubating conditions were significantly increased in the AP (87%) and the CS (77%) compared with the OO (32%) after a dose of 0.6 mg kg(-1) of rocuronium (P<0.05). CONCLUSIONS: After administration of rocuronium, twitch monitoring at the OO allows a faster intubation but is associated with an unacceptable incidence of inadequate intubating conditions. Excellent intubating conditions are observed most frequently with AP monitoring but with the longest delay before intubation is attempted. Monitoring of the CS allows intubation earlier than that of AP with fewer patients having excellent but no patients having inadequate intubating conditions.
Assuntos
Androstanóis/farmacologia , Intubação Intratraqueal/métodos , Relaxamento Muscular/efeitos dos fármacos , Músculo Esquelético/efeitos dos fármacos , Fármacos Neuromusculares não Despolarizantes/farmacologia , Adulto , Androstanóis/administração & dosagem , Anestesia Geral/métodos , Relação Dose-Resposta a Droga , Eletroencefalografia/efeitos dos fármacos , Pálpebras , Músculos Faciais/efeitos dos fármacos , Músculos Faciais/fisiologia , Nervo Facial/fisiologia , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Laringoscopia , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Relaxamento Muscular/fisiologia , Músculo Esquelético/fisiologia , Bloqueio Neuromuscular/métodos , Fármacos Neuromusculares não Despolarizantes/administração & dosagem , Estudos Prospectivos , Rocurônio , Polegar , Adulto JovemRESUMO
Compared to nerve stimulation or classic paraesthesia techniques, ultrasound (US)-guided popliteal sciatic nerve block requires a smaller volume of local anaesthetic. The up-and-down method was used to determine the minimum effective anaesthetic volume of 0.5% ropivacaine necessary for US-guided popliteal sciatic nerve block to achieve successful surgical anaesthesia for foot and ankle surgery. The study included 32 patients receiving an US-guided popliteal sciatic nerve bock. The starting dose of 0.5% ropivacaine was set at 30 ml, which was decreased by 3 ml if the block succeeded and increased by 3 ml if the block failed. After the injection of local anaesthetic, the degree of sensory and motor blockade of the tibial and common peroneal nerves was assessed every 5 minutes for 30 minutes. The ED50 and ED95 volumes of local anaesthetic were 6 ml and 16 ml, respectively. The success rates of sensory blockade of the tibial nerve and common peroneal nerve were 69% and 88%, respectively. The success rates of motor blockade of these nerves were 75% and 90%, respectively. The ED50 and ED95 of 0.5% ropivacaine for US-guided popliteal sciatic nerve block were 6 ml and 16 ml, respectively.
Assuntos
Amidas/farmacocinética , Anestésicos Locais/farmacocinética , Pé/cirurgia , Nervo Isquiático/efeitos dos fármacos , Ultrassonografia de Intervenção/métodos , Adulto , Tornozelo/cirurgia , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , RopivacainaRESUMO
Malaria was steadily decreasing in Korea except in certain counties of the mountainous and hilly areas, in the 1960s. Judging from the present epidemiological, social and economic conditions, it can be said with confidence that malaria with "unstable" characteristic in the Republic of Korea has already been disappeared. No doubt, the causes of the disappearance of malaria are complex. Certainly improved living conditions and life style; better medical and educational facilities in the wake of a rapid economic development could all have some role. On the other hand, the disappearance of malaria without large scale control operations could be ascribed to the two main factors: one is malaria case detection and simultaneous drug therapy available through the nation-wide passive case detection network during the 1960s and the other is rapidly improved farming practices begun in 1970s, which resulted in the use of a huge quantity of pesticides and other chemicals for agriculture, which, in turn, might affect local anopheline vectors which were originally not effective ones any way.
Assuntos
Malária/epidemiologia , Humanos , Coreia (Geográfico)RESUMO
We have compared the dose-response relationships of mivacurium, pancuronium and their combination, and examined the interactions by isobolographic and fractional analyses. We studied 70 adult patients during nitrous oxide-fentanyl-propofol anaesthesia. The dose-response curves were determined by probit analysis. The ED95 and ED50 values for mivacurium were 84.2 (95% confidence interval 80.2-88.1) micrograms kg-1 and 46.2 (40.2-52.1) micrograms kg-1, respectively. Corresponding values for pancuronium were 68.5 (63.7-73.2) micrograms kg-1 and 40.7 (35.5-45.9) micrograms kg-1, respectively. Isobolographic and fractional analyses of the mivacurium-pancuronium combination demonstrated a synergistic interaction. An additional 30 patients were allocated randomly to receive either mivacurium 84.2 micrograms kg-1 (n = 15) or pancuronium 68.5 micrograms kg-1 (n = 15). When the first twitch (T1) of TOF recovered to 25%, each patient received mivacurium 46.2 micrograms kg-1. The times after administration of mivacurium until T1 25% in the mivacurium-pancuronium group were 6.4 (3.5-9.4) min and 49.8 (44.7-54.9) min, respectively (P < 0.0001). We conclude that the combination of mivacurium and pancuronium was synergistic and after pancuronium-induced neuromuscular block, mivacurium became a longer acting agent than the shorter agent.
Assuntos
Isoquinolinas/farmacologia , Bloqueio Neuromuscular , Junção Neuromuscular/efeitos dos fármacos , Fármacos Neuromusculares não Despolarizantes/farmacologia , Pancurônio/farmacologia , Adulto , Anestesia Geral , Relação Dose-Resposta a Droga , Sinergismo Farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , MivacúrioRESUMO
Recent reports in the literature strongly support the idea that cement is the optimum form of fixation of the femoral component in total hip replacement. For hybrid total hip arthroplasty, we used a cemented cup instead of an uncemented cup since this was inevitable in cases of poorly developed acetabulum. The uncemented cone femoral component is also beneficial in cases of extremely narrow and cylindrical configuration of the medullary cavity of untreated congenital dislocation of the hips (CDH) and tuberculosis or septic arthritis in childhood. We reviewed the clinical result of a consecutive series of patients with cemented total hip arthroplasty (THA) compared with recent studies on hybrid reconstruction using survivorship analysis. This subsequent study involved a hybrid uncemented Wagner cone femoral component and a cemented acetabular component with roof reinforcement by additional impacted cancellous allograft with hydroxyapatite (HA). We believe that early failure of the cemented components was due to an adverse effect of thin cement mantles around cemented femoral stems as well as the cemented cup in THA. In addition, 8 patients who received our modification of the Charnley CDH component had poor results even though we reduced the stem geometry and thickness. Furthermore, intraoperative fracture and splitting of the proximal femur was a major complication during implantation. Contrary to expectations, the results of these hybrid reconstructions were extremely encouraging (average follow-up period of 2-4.5 years). In addition to our experience of the cemented versus hybrid THA involving the uncemented Wagner femoral component, we have determined positive indications for the untreated and severely distorted anatomy of bilateral CDH for which surgical interventions for reconstruction were not recommended before.
Assuntos
Artroplastia de Quadril , Cimentação , Luxação do Quadril/cirurgia , Articulação do Quadril/patologia , Adulto , Artrite Infecciosa/complicações , Feminino , Seguimentos , Luxação do Quadril/etiologia , Luxação do Quadril/patologia , Luxação Congênita de Quadril/cirurgia , Prótese de Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Reoperação , Análise de Sobrevida , Tuberculose Osteoarticular/complicaçõesRESUMO
UNLABELLED: We compared the dose-response relationships and the neuromuscular blocking effects of mivacurium and rocuronium after chronic isepamicin therapy for 7 days in 56 anesthetized rabbits. Train-of-four stimuli were applied every 10 s to the common peroneal nerve, and the force of contraction of the tibialis anterior muscle was measured. Chronic isepamicin therapy is associated with a rightward shift of the mivacurium and rocuronium dose-response curves. The effective dose for 50% twitch depression of mivacurium and rocuronium increased significantly, from 16.9 +/- 4.8 and 56.5 +/- 5.3 microg/kg, respectively, with placebo to 30.6 +/- 5.3 and 75.6 +/- 4.7 microg/kg, respectively, during isepamicin therapy. The isepamicin rabbits receiving mivacurium 0.18 mg/kg or rocuronium 0.6 mg/kg had an accelerated recovery from neuromuscular blockade compared with those receiving placebo. The results of this study show that mivacurium and rocuronium have both a decreased effect and a shorter duration of action in rabbits when used during concurrent isepamicin therapy. IMPLICATIONS: We studied the dose-response relationships and the neuromuscular blocking effects of mivacurium and rocuronium during chronic isepamicin therapy in rabbits. Mivacurium and rocuronium have both a decreased effect and a shorter duration of action during chronic aminoglycoside antibiotic therapy in rabbits.
Assuntos
Androstanóis/farmacologia , Antibacterianos/administração & dosagem , Isoquinolinas/farmacologia , Fármacos Neuromusculares não Despolarizantes/farmacologia , Animais , Relação Dose-Resposta a Droga , Esquema de Medicação , Resistência a Medicamentos , Sinergismo Farmacológico , Feminino , Gentamicinas/administração & dosagem , Masculino , Mivacúrio , Coelhos , RocurônioRESUMO
We reported 8 to 13 years of follow-up of cases of tuberculosis of the hip previously. Now we report on 60 cases of hip tuberculosis treated with total hip arthroplasty. The results have been reasonably acceptable, with the longest follow-up >28 years. Prosthetic life was limited to at most 20 years in our longest cases mainly because of loss of fixation of the acetabular component. There were recurrences of tuberculosis in 5 hips. We confirmed that antituberculous chemotherapy is crucial in total hip arthroplasty reconstruction. Detection of Mycobacterium tuberculosis using polymerase chain reaction may provide rapid diagnosis and follow-up for treatment response.
Assuntos
Artroplastia de Quadril/métodos , Articulação do Quadril/cirurgia , Tuberculose Osteoarticular/cirurgia , Adulto , Antituberculosos/uso terapêutico , Feminino , Seguimentos , Articulação do Quadril/diagnóstico por imagem , Prótese de Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Recidiva , Reoperação , Resultado do Tratamento , Tuberculose Osteoarticular/diagnóstico por imagem , Tuberculose Osteoarticular/tratamento farmacológicoRESUMO
As a suitable emergency measure to arrest epidemics of Japanese encephalitis in Korea, the ultra-low-volume method of spraying insecticide to control the mosquito vector Culex tritaeniorhynchus has been tested in 2 successive years over a 16-km (2) area, utilizing a large fixed-wing aircraft. Malathion concentrate applied at 0.36 litres/ha gave insufficient control of the parous (infective) females, and no reduction in total numbers of this species. Fenitrothion concentrate applied at 0.45 litres/ha resulted in a 77-87% reduction in total numbers and an 87-98% reduction in parous females over a 4-day period.
Assuntos
Aeronaves , Culex , Encefalite Japonesa/prevenção & controle , Fenitrotion/administração & dosagem , Malation/administração & dosagem , Controle de Mosquitos , Animais , Humanos , Insetos Vetores , Coreia (Geográfico) , MétodosRESUMO
OBJECTIVE: The purpose of this study was to evaluate the CT features of intraperitoneal manifestations with parasitic infestation in nine patients. CONCLUSION: The CT features of intraperitoneal manifestations of parasitic infestation were single or multiple multiseptated cystic masses in the peritoneal cavity, hazy omental infiltration, or both. Recognizing these features is important to establish an early diagnosis that leads to rapid treatment and helps avoid unnecessary surgery.
Assuntos
Helmintíase/diagnóstico por imagem , Enteropatias Parasitárias/diagnóstico por imagem , Doenças Peritoneais/diagnóstico por imagem , Doenças Peritoneais/parasitologia , Tomografia Computadorizada por Raios X , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
The CYP2D6 gene codes for human cytochrome P450 2D6 enzyme, which is responsible for the metabolism of many psychiatric drugs. In schizophrenic patients treated with neuroleptics, decreased or loss of function CYP2D6 alleles may contribute to the development of tardive dyskinesia (TD), a movement disorder that frequently occurs with chronic neuroleptic treatment. The goal of this study was to determine whether the occurrence of TD is associated with CYP2D6 genotype in a cohort of Korean schizophrenics by employing a CYP450 GeneChip((R)) oligonucleotide microarray and PCR assays to screen for 19 CYP2D6 alleles. Our results revealed that males with at least one decreased or loss of function allele have a moderately greater chance of developing TD than males with only wild-type alleles. Female schizophrenics did not have a significantly greater chance of developing TD. Our results demonstrate the utility of CYP2D6 microarrays to assess genotype status in this Korean cohort.
Assuntos
Citocromo P-450 CYP2D6/genética , Discinesia Induzida por Medicamentos/genética , Esquizofrenia/genética , Adolescente , Adulto , Idoso , Feminino , Frequência do Gene/genética , Genótipo , Humanos , Coreia (Geográfico) , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Análise de Sequência com Séries de Oligonucleotídeos/métodos , Análise de Sequência com Séries de Oligonucleotídeos/estatística & dados numéricos , Esquizofrenia/tratamento farmacológico , Fatores Sexuais , Estatísticas não ParamétricasRESUMO
On June and July 1994, two cases of vivax malaria were consecutively diagnosed at the Yongsan Hospital, Chung-Ang University in Seoul. The first patient was a soldier serving in western parts of the demilitarized zone (DMZ) while the second case was a resident of a village near DMZ. Neither patients had history of being abroad. Republic of Korea (ROK) has been free of malaria since the mid-1970s except for imported cases. The two vivax malaria cases, together with an additional patient detected in 1993, occurred in relatively small areas near DMZ. This necessitated an epidemiologic surveillance. When medical records and blood smears in the areas were examined, no other cases were found. Of 7,723 mosquitoes collected by a black light trap for two nights in June, 7,066 (91.5%) were Anopheles sinensis. In order to evaluate a significance of the recent malaria occurrence, a surveillance system should be operated in the areas.
Assuntos
Malária Vivax/epidemiologia , Adulto , Feminino , Humanos , Coreia (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-IdadeRESUMO
We assessed the changes of plasma haloperidol concentrations and clinical responses repeatedly up to 4 weeks after coadministration or discontinuation of rifampin in 12 schizophrenic patients taking haloperidol alone (group I) and 5 patients taking haloperidol and antituberculotic drugs (group II). After coadministration of rifampin in group I, daily trough haloperidol concentrations rapidly decreased and reached 63% of baseline level by day 3, 41.3% by day 7, and 30% by day 28. On the other hand, after discontinuation of rifampin in group II, plasma haloperidol concentration increased to 140.7% of baseline level by day 3, 228.7% by day 7, and 329% by day 28. In this study, a 30% or greater change in the clinical rating scale was considered a positive clinical response of the drug interaction. Using this criterion, 50% of the group I subjects responded according to the Brief Psychiatric Rating Scale (BPRS) total score, and 25% responded according to the BPRS subscale for psychiatric symptoms. No positive responses were observed in group II patients. These results strongly suggest that rifampin interacts with the clinical effects as well as the plasma concentrations of coadministered haloperidol, and careful monitoring should be considered when coadministration or discontinuation of rifampin is needed in a schizophrenic patient taking haloperidol.
Assuntos
Antibióticos Antituberculose/farmacologia , Antipsicóticos/farmacocinética , Haloperidol/farmacocinética , Rifampina/farmacologia , Esquizofrenia/tratamento farmacológico , Tuberculose/tratamento farmacológico , Adulto , Interações Medicamentosas , Quimioterapia Combinada , Feminino , Haloperidol/administração & dosagem , Haloperidol/sangue , Humanos , Masculino , Rifampina/administração & dosagem , Esquizofrenia/sangueRESUMO
PURPOSE: The purpose of this work was to evaluate the usefulness of CT scans for distinguishing torsed from uncomplicated benign cystic teratoma (BCT). METHOD: Retrospective analysis was performed in 14 torsed BCTs (14 patients) and in 23 uncomplicated BCTs (20 patients) for comparison. The features on CT scans were compared to the pathologic findings. RESULTS: CT findings indicating torsed BCT were the presence of eccentric wall thickening of >1 cm, peritumoral infiltration, and presence of enlarged solid tubal mass adjacent to the uterus (p < 0.05). CONCLUSION: The present study suggests that CT is useful in differentiating torsed from uncomplicated BCT. Although CT findings are not specific for some patients, detection of certain CT findings could increase the diagnostic accuracy.