ABSTRACT
Esse trabalho pretende uma revisão da bibliografia sobre aspectos específicos da biologia do Aedes aegypti com relevância para ações de controle, com base nos manuais do Ministério da Saúde (MS). Procuramos lacunas técnicas frente ao conhecimento atual desse vetor na literatura especializada, tentando fornecer um quadro de referências e diretrizes técnicas para o planejamento e implementação de ações de vigilância, prevenção e controle de Ae. aegypti com base na estratificação de risco para apoiar a construção de possíveis cenários operacionais em nível local. Os cenários operacionais servem como referência para a seleção das ferramentas de controle de vetores mais apropriadas, visando tornar seu uso mais eficiente. A revisão dos manuais do MS pode permitir a sua atualização no futuro, com uma análise crítica dos novos conhecimentos e metodologias que ficaram disponíveis nos últimos anos. Para essa revisão foram escolhidos cinco tópicos chave: Bioecologia de Ae. aegypti e sua importância para fins de vigilância e controle; Vigilância entomológica; Controle vetorial; Cenários operacionais para abordar a vigilância e controle de Ae. aegypti; Estratificação de risco nos cenários. O conhecimento atual sobre esses tópicos foi levantado em diferentes bases de dados (Web of Science, SciELO e PUBMED). Além disso, os manuais do MS e da Fundação Nacional de Saúde (FUNASA), que são antigos e não possuem versão digital, foram digitalizados e serão disponibilizados para o público em site do ProgramaEssa revisão, bem como seus desdobramentos, visa, principalmente: sugerir aos gestores levarem em conta cenários operacionais que se formam nas ocorrências de vetores; utilizar esses cenários como referência para a seleção das ferramentas de controle de vetores mais apropriadas e seu uso mais eficiente, baseados em fatos entomológicos e epidemiológicos locais; orientar os profissionais da ponta a colaborar na tomada de decisão dos gestores municipais quanto a efetividade do uso das melhores metodologias e tecnologias disponíveis, que mais se adequem à situação de risco apresentada e à disponibilidade de recursos, de forma racional, acarretando melhor custo/benefício para os municípios e em prol da saúde de sua população. (AU)
In this work we proposed the literature review on specific aspects of Aedes aegypti biology that are relevant to control actions, based on the Brazilian Ministry of Health manuals. We looked for technical gaps in relation to the current knowledge on this vector in the specialized literature and provided a reference framework and guidelines in techniques for the planning and implementation of surveillance, prevention, and control actions against Ae. aegypti that are based on risk stratification to support the construction of possible local operational scenarios. Operational scenarios may serve as a reference for selecting the most appropriate vector control tools and their most efficient use. The revision of the Ministry of Health manuals suggested a necessity for updating them in the future, with a critical analysis of the new knowledge and methodologies that became available in the recent years. For this review five key topics were chosen: Aedes aegypti Bioecology and its importance for surveillance and control purposes; Entomological surveillance; Vector control; Operational scenarios for addressing Aedes aegypti surveillance and control; Risk stratification in scenarios. Current knowledge on these topics was gathered from different databases (Web of Science, Scielo and PUBMED). In addition, the manuals of Brazilian Ministry of Health and FUNASA (National Health Foundation), which exist only in print, were scanned, and will be made digitally available to the public on a website. This review, as well as its developments, suggests that field agents may take into account operational scenarios that form in vector occurrences. These scenarios may serve as a reference for the selection of the most appropriate vector control tools and their best use based on local entomological and epidemiological factsThis may improve decision-making to use the best available methodology and technology, which suit better their risk situation and resource availability, in a rational, cost-effective strategy for the health improvement of different urban populations.(AU)
Subject(s)
Arbovirus Infections , Mosquito Control , Data Collection , Aedes , Vector Control of Diseases , Surveillance in Disasters , Contingency Plans , Public Health SurveillanceABSTRACT
@#Epilepsy is one of the main health problems in neurology that can lead to cognitive decline. Generally, the epilepsy-associated cognitive decline is influenced by demographic, clinical, and treatment characteristics. This study aimed to determine the characteristics of cognitive status of epilepsy patients who received monotherapy using first-generation antiepileptic drugs (AEDs), namely phenytoin, carbamazepine, and valproic acid. It involved 93 epilepsy patients of Mutiara Sukma Mental Hospital (n=38) and Mataram General Hospital (n=55). Besides, 93 healthy patients were assigned as healthy control group (HC) subjects (n=93). Demographic characteristics collected from epilepsy and HC groups were age, gender, and years of education. Clinical characteristics taken from both groups were MoCA-Ina score. Clinical characteristics taken from epilepsy group were age at epilepsy onset, type of seizure (partial vs generalized), etiology (idiopathic vs structural), first-generation AED used, years of treatment, and cognitive status. The result of the study revealed that there were no significant different between the two groups in the means of age and years of education as well as the frequency of male gender (p>0.05). The mean of MoCA-Ina score of epilepsy group was significantly lower compared with HC group (p<0.05). The frequency of cognitive decline among epilepsy patients was 75.3%. The cognitive functions of epilepsy patients using monotherapy with carbamazepine, phenytoin, or valproic acid was significantly lower compared with healthy subjects. We conclude that there was high prevalence of epilepsy-associated cognitive impairment which was associated with male gender.
ABSTRACT
Background: Epilepsy requires lifelong therapy with antiepileptic drugs (AEDs) and having medical and psychological consequence. So, the present study was conducted to evaluate the role of different AEDs on thyroid profile in epileptic patients.Methods: 50 epileptic patients receiving AEDs for minimum 1 year were recruited as study group and 50 healthy subjects considered as control group. These subjects were recruited from general (rural or urban) community of Punjab. Fasting blood samples were drawn from patients and healthy subjects for the evaluation of triiodothyronine (T3), thyroxine (T4) and thyroid stimulating hormone (TSH) levels.Results: Significant increase in TSH levels were recorded in epileptic patients while no significant change was found in T3 and T4 epileptic patients treated with different AEDs with respect to healthy controls. Maximum increase in TSH was seen in phenytoin, treated epileptic patients and maximum fall in TSH was recorded in levetiracetam treated epileptic patients. Maximum increase in T3 and T4 levels was found in phenytoin while a maximum decrease was recorded T3 and T4 levels in carbamazepine treated epileptic patients in comparison to other drugs treated patients.Conclusions: Aforementioned observations suggested that epileptic patients treated with phenytoin, valproic acid, carbamazepine and levetiracetam for long time could cause initiation of subclinical hypothyroidism further could leads to overt hypothyroidism which in turn responsible for pathophysiology of various coronary heart disease. Routine screening of thyroid profile during chronic use of AEDs is recommended.
ABSTRACT
Una de cada cinco muertes en adultos en países desarrollados se debe a causas cardiovasculares; la mitad de esas muertes se produce de forma súbita y un gran porcentaje en el ámbito extrahospitalario. Las medidas de prevención se dividen en: aquellas destinadas a prevenir en primer lugar que el evento de muerte súbita cardíaca suceda, y aquellas cuyo objetivo es actuar en el momento en que el evento de muerte súbita está sucediendo. Las primeras tienen como objetivo disminuir las principales causas de muerte súbita en países desarrollados: las cardiopatías estructurales (cuya principal causa es la enfermedad coronaria). En este sentido, con el fin de intentar paliar el desarrollo de una cardiopatía que predisponga a la aparición de arritmias fatales y la MSC, se implementan medidas de prevención primarias higiénico-dietéticas y farmacológicas (con el objetivo de disminuir y el controlar los factores de riesgo) y, en aquellos con enfermedad cardiovascular ya establecida, se implementan las estrategias secundarias farmacológicas y/o quirúrgicas (revascularización, reemplazo valvular, etc.). El segundo abordaje surge del hecho de que, a pesar de todas estas medidas, un gran número de pacientes presentará eventos arrítmicos en el ámbito extrahospitalario (MSCEH), ya sea porque aunque recibieron el tratamiento óptimo presentan aún un elevado riesgo de MSC, porque no fueron diagnosticados a tiempo o porque a pesar de haber hecho estudios complementarios el diagnóstico es muy dificultoso. Existen dos estrategias: la primera son los dispositivos de cardiodesfibrilación implantables (o, más recientes, los chalecos vestibles). Estos aparatos están indicados para una población seleccionada, sea por haber presentado ya un episodio de muerte súbita abortado, o por presentar una cardiopatía (estructural o genética) que predisponga a una mayor probabilidad de sufrir un evento. La segunda estrategia es la educación y el desarrollo de programas de salud pública que permitan capacitar a la población general en la realización de RCP y el uso de desfibriladores automáticos externos (DEAs), los cuales deberían estar disponibles en cualquier lugar público. Múltiples estudios demostraron que el acceso de la población general al aprendizaje de maniobras de RCP sencillas y pragmáticas y la presencia de DEAs se traduce en un gran aumento de sobrevida sin secuelas en víctimas de MSCEH. (AU)
One of every five deaths in adults is due to cardiovascular causes, in developed countries, and half of these deaths will occur suddenly. A large percentage occur in the out of hospital setting, so measures to prevent it are divided into: those designed to prevent, in the first place, the sudden cardiac death event from happening and those whose purpose is to act when the sudden death event that has already occurred and it´s ongoing. The first aims to reduce the main causes of sudden death in developed countries: structural heart disease (with coronary heart disease as its main cause). In this regard, with the purpose to mitigate the development of a heart disease that predisposes the occurrence of fatal arrhythmias and SCD, we have primary prevention measures, like healthy life style conduct with or without pharmacological treatment, (whose objective is the reduction and control of cardiovascular risk factors) and, in those with cardiovascular disease already established, there is an implementation of pharmacological and / or surgical strategies (Revascularization, valve replacement, etc.). The second objective arises from the fact that, despite all these preventive and therapeutic measures, a large number of patients will present out-of-hospital cardiac arrest (OHCA) either because although they received optimal treatment they still remain in high risk of SCD, even because they were not diagnosed on time, or because despite having complementary studies made the diagnosis is very difficult. There are two well strategies: the first are implantable cardio-defibrillation devices (or, more recently, wearable vests). These are indicated for a selected population, either because they have already presented an episode of sudden aborted death, or because they have heart disease (structural or genetic), which predisposes to a greater probability of suffering an event. The second strategy is the education and development of public health programs that enable the general population to be trained in CPR and the use of external automatic defibrillators. (AEDs) should be available in any public place. Multiple studies showed that access to the general population for learning simple and pragmatic CPR maneuvers and the presence of AEDs is making an impact on a significant increase in survival without consequences in OHCA victims. (AU)
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Ventricular Fibrillation/complications , Death, Sudden, Cardiac/etiology , Death, Sudden, Cardiac/prevention & control , Death, Sudden, Cardiac/epidemiology , Cardiopulmonary Resuscitation , Tachycardia, Ventricular/complications , Electric Countershock , Incidence , Cause of Death , Age Factors , AthletesABSTRACT
Background: Epilepsy is a common neurological disorder in children and its treatment still remains a challenge for the physicians. Though there are a number of anti-epileptic drugs with varying mechanisms of action, their adverse effects, and drug interactions are to be analyzed before starting a therapy. Aim: To study the pattern of prescription in the treatment of pediatric seizures. Objectives: To observe the pharmaco-epidemiology, utilization pattern and effectiveness of monotherapy and polytherapy in the treatment of seizures in children aged above 2 years. Materials and methods: This prospective, longitudinal study was conducted for a period of 8months in Paediatric Neurology Department of a tertiary care teaching hospital. The data collected from 41 children at the end of the study, were compiled in a specially designed data form and were analyzed. Henry Daniel Raj T, Sylvia A, Chidambaranathan S, nirmala P. Monotherapy and polytherapy in Paediatric seizures: A prospective, observational study in a tertiary care teaching hospital. IAIM, 2017; 4(10): 97-104. Page 98 Results: The distribution of Paediatric seizures was found to be high in male children (62%) and in the age group of 2 to 5 years (46%). GTCS (85%) was the dominant type of seizure seen in children and 83% of the children were treated with monotherapy. Polytherapy was found to be efficacious compared to monotherapy, with a good seizure control (100%: 94%), good compliance and minimal adverse effects (14.2%: 14.7%). Conclusion: Monotherapy still remains the mainstay of treatment in pediatric seizures. Though polytherapy appears to be a better option in this study, epilepsy in children requires a long term treatment and hence adverse effects in long term and the effects of drug interactions are the main criteria to be taken care of. A study of longer duration in the treatment of pediatric seizures will provide a better knowledge in the adverse effects of polytherapy.
ABSTRACT
Epilepsy is a chronic disease occurring in approximately 1.0% of the world's population. About 30% of the epileptic patients treated with availably antiepileptic drugs (AEDs) continue to have seizures and are considered therapy-resistant or refractory patients. The ultimate goal for the use of AEDs is complete cessation of seizures without side effects. Because of a narrow therapeutic index of AEDs, a complete understanding of its clinical pharmacokinetics is essential for understanding of the pharmacodynamics of these drugs. These drug concentrations in biological fluids serve as surrogate markers and can be used to guide or target drug dosing. Because early studies demonstrated clinical and/or electroencephalographic correlations with serum concentrations of several AEDs, It has been almost 50 years since clinicians started using plasma concentrations of AEDs to optimize pharmacotherapy in patients with epilepsy. Therefore, validated analytical method for concentrations of AEDs in biological fluids is a necessity in order to explore pharmacokinetics, bioequivalence and TDM in various clinical situations. There are hundreds of published articles on the analysis of specific AEDs by a wide variety of analytical methods in biological samples have appears over the past decade. This review intends to provide an updated, concise overview on the modern method development for monitoring AEDs for pharmacokinetic studies, bioequivalence and therapeutic drug monitoring.
Subject(s)
Humans , Anticonvulsants , Biomarkers , Chronic Disease , Drug Monitoring , Epilepsy , Plasma , Seizures , Therapeutic EquivalencyABSTRACT
@#Objective To explore the impact of the different antiepileptic drugs on cognitive function in patients with epilepsy.Methods There are 280 cases of patients with epilepsy from Department of Neurology in our hospital out-patient and hospitalization, while 32 cases are the normal control group. The patients were randomly divided into groups of topiramate, carbamazepine and sodium valproate group and topiramate plus valproate combined therapy group. Wechsler Memory Scale was used by the patients before and after treatment to assess cognitive function, and compared with the normal group. Results Carbamazepine monotherapy group and the valproate group were no significant difference in areas of cognitive function belong to the normal level; Topiramate monotherapy group cognitive function was significantly lower than normal, the joint drug group was the most of the lower level of cognitive function. Conclusion Carbamazepine and valproate monotherapy were applied had the minor cognitive impairment, combination therapy of epilepsy in patients had severe cognitive impairment.
ABSTRACT
PURPOSE: To report characteristics of out-of-hospital cardiac arrest (OHCA) patients in whom 119 rescuers used an automated external defibrillator (AED) in the metropolitan area METHODS: 1,689 OHCA patients were transferred to hospitals by 119 rescuers between 1 January and 31 December, 2006. Among them, 106 OHCA patients for whom 119 rescuers used an AED were enrolled retrospectively. RESULTS: Shockable rhythm with AED use was 70.8%, witnessed arrest was 46.2%, and bystander cardiopulmonary resuscitation (CPR) was 6.6%. The most common location of cardiac arrest was in the home, at 74.5%. Response time was 7.1(+/-3.9) minutes. Chest compression during transport was done by 119 rescuers in 87.7% of cases, and assisted ventilations such as advanced airway management and bag valve mask ventilation were performed by 119 rescuers in 17.0%. Initial ECG findings at ED were asystole(59.4%), PEA(25.5%), VF/pulseless VT(8.5%), sinus rhythm(4.7%), and others(1.9%). The most common etiology of cardiac arrest was presumed cardiac origin in 68.9% of cases. Sustained return of spontaneous circulation (ROSC) was 26.4%. The proportion of patients discharged alive was 11.3%. CONCLUSION: The performance of bystander CPR and usage of AED, and appropriate CPR done by 119 rescuers were unsatisfactory in metropolitan Daegu. There is a marked need to establish basic life support education in the areas of bystander CPR, and a quantitative and qualitative development of 119 rescue capability.
Subject(s)
Humans , Airway Management , Cardiopulmonary Resuscitation , Defibrillators , Electrocardiography , Heart Arrest , Masks , Out-of-Hospital Cardiac Arrest , Reaction Time , Thorax , Ventilation , Wit and Humor as TopicABSTRACT
PURPOSE: There is no apparent consensus about the successful policy of antiepileptic drug (AED) withdrawal, nor about definite factors to make patients remain seizure-free. We attempted to find out the predictive factors for seizure relapse after withdrawal of AED in patients with cryptogenic partial epilepsy. METHODS: This is a case-controlled and hospital-based observational study. A total of 91 crytogenic partial epileptic patients in whom seizure had been successfully controlled by AED monotherapy for more than two years were subjected to drug withdrawal. Patients with history of febrile convulsion, status epilepticus, and abnormal intelligence were excluded. Subjects were divided into two groups; the first group consisted of patients with seizure free more than 2 years after withdrawal of AED and another group with seizure recurrence during tapering or after drug withdrawal. The group with successful withdrawal had 48 patients, and, in 43 patients, seizure was recurred. Clinical profiles were compared between the two groups. RESULTS: There was no significant difference in gender, family history, age at onset, number of seizure attacks before AED initiation, duration of illness before treatment, and seizure or epilepsy classifications between the two groups. However, an abnormal EEG finding was associated with seizure relapse (Chi-square test p<0.05). On the other hand, the number of seizure attacks and the interval between the AED initiation and the time when a seizure free period was achieved had a correlation with seizure relapse, but was not statistically significant. CONCLUSIONS: Abnormal EEG findings was the predictive factor for seizure relapse after withdrawal from AED monotherapy in cryptogenic partial epilepsy.
Subject(s)
Humans , Case-Control Studies , Classification , Consensus , Electroencephalography , Epilepsies, Partial , Epilepsy , Hand , Intelligence , Observational Study , Recurrence , Seizures , Seizures, Febrile , Status EpilepticusABSTRACT
To consider current concepts of epilepsy further, the brief review begins with a discussion of what is epilepsy, discribes multifactorial nature of epileptic disorders, and ends with a presentation of current classifications. A combination of the standard antiepielptic drugs(AEDs) may be necessary to treat intractable seizures, but no studies have been done to indicate an optimal combination. The new AEDs provide alternative choices, but questions remain about the optimal timing and manner of administration. AEDs selection must individualized, no drug of choice can be named for all patients.