Complicações relacionadas ao uso de polimetilmetacrilato na face: Análise de 209 casos / Complications related to the use of polymethyl methacrylate on the face: Analysis of 209 cases

Introdução: O polimetilmetacrilato é um produto de preenchimento permanente. A injeção deste material na face pode levar a complicações. O objetivo deste estudo é determinar em uma série de casos o tempo mediano de ocorrência de complicações, as áreas mais comprometidas, os tipos de complicações e tratamentos mais realizados. Método: Foram estudados 209 casos de pacientes portadores de complicações relacionadas ao uso de polimetilmetacrilato na face que buscaram tratamento entre o período de janeiro de 2000 a junho de 2021. Os dados analisados foram sexo, idade, número de injeções, momento da aplicação, intervalo de tempo até surgir a complicação, tipo de complicação, região comprometida e tratamento realizado. Resultados: A idade média dos pacientes foi de 45 anos (23 a 79 anos). Destes, 172 eram mulheres e 37 homens. O número de aplicações variou de 1 a 5. O tempo mediano de surgimento de complicações foi de 71 meses. As regiões mais comprometidas foram a malar, em 102 pacientes; mandibular, em 100; e zigomática, em 91. Granuloma foi observado em 135 pacientes; edema, em 120; e inflamação, em 78. O tratamento mais realizado foi a injeção de corticoide, em 111 pacientes, seguido de remoção cirúrgica, em 40. Conclusão: Os resultados podem servir como base de conhecimento para uma melhor compreensão das complicações com o uso de polimetilmetacrilato na face.

Introduction: Polymethylmethacrylate is a permanent filler product. Injecting this material into the face can lead to complications. The objective of this study is to determine in a series of cases the median time for complications to occur, the most affected areas, the types of complications, and the treatments most performed. Method: 209 cases of patients with complications related to the use of polymethyl methacrylate on the face who sought treatment between the period of January 2000 and June 2021 were studied. The data analyzed were gender, age, number of injections, moment of application, interval time until the complication arises, type of complication, affected region, and treatment performed. Results: The average age of patients was 45 years (23 to 79 years). Of these, 172 were women and 37 men. The number of applications ranged from 1 to 5. The median time for complications to appear was 71 months. The most affected regions were the malar, in 102 patients; mandibular, in 100; and zygomatic, in 91. Granuloma was observed in 135 patients; edema, in 120; and inflammation, in 78. The most common treatment was corticosteroid injection, in 111 patients, followed by surgical removal, in 40. Conclusion: The results can serve as a knowledge base for a better understanding of complications with the use of polymethylmethacrylate in the face.

Plomo y mercurio en personas víctimas del conflicto armado en Bojayá, Chocó: estudio descriptivo / Lead and mercury in victims of the armed conflict in Bojayá, Chocó: a descriptive study / Chumbo e mercúrio em vítimas do conflito armado em Bojayá, Chocó: um estudo descritivo

Introducción: En los contextos del conflicto armado convergen actividades que potencialmente pueden producir toxicidad por metales pesados; inclusive, muchas víctimas de artefactos explosivos improvisados portan esquirlas residuales interiorizadas, de composición y potencial toxicidad desconocidas. Ello ha sido poco estudiado. Objetivo: Describir los niveles biológicos de plomo y mercurio en civiles supervivientes de la masacre de Bojayá, su eventual exposición actual, así como signos y síntomas compatibles con toxicidad crónica. Metodología: Estudio observacional descriptivo, tipo serie con 13 casos. Resultados: El 38.46 % de los casos tuvo niveles de plomo en sangre superiores o cercanos al valor límite superior, sin fuentes específicas identificadas. Un 46.15 % tuvo niveles mercuriales superiores o cercanos al límite de referencia, y se los considera exposición ambiental por minería aurífera regional. La valoración clínica toxicológica mostró síntomas y signos clínicos potencialmente asociados con toxicidad crónica por metales. Conclusión: Hubo presencia de residuos de artefactos explosivos en personas con hallazgos sugestivos de toxicidad por plomo o mercurio, sin que pueda afirmarse una relación directa y específica entre los dos aspectos; algunos casos sugieren exposición ambiental para mercurio, y exposición a proyectiles para el plomo, relacionadas con dinámicas del conflicto armado. Son necesarios estudios adicionales para afirmar la existencia de asociaciones causales.

Introduction: In the contexts of armed conflict, activities converge that can potentially produce heavy metal toxicity; including many victims of improvised explosive devices carry internalised residual shrapnel, of unknown composition and potential toxicity. This has been little studied. Objective: To describe the biological levels of lead and mercury in civilian survivors of the Bojayá massacre, their possible current exposure, as well as signs and symptoms compatible with chronic toxicity. Methodology: Descriptive observational study, serial type with 13 cases. Results: 38.46 % of the cases had blood lead levels above or close to the upper limit value, with no specific sources identified. 46.15 % had mercury levels above or close to the reference limit, and were considered environmental exposure from regional gold mining. Clinical toxicological assessment showed clinical signs and symptoms potentially associated with chronic metal toxicity. Conclusion: There was a presence of explosive ordnance residues in individuals with findings suggestive of lead or mercury toxicity, without a direct and specific relationship between the two; some cases suggest environmental exposure for mercury, and projectile exposure for lead, related to the dynamics of the armed conflict. Further studies are needed to affirm the existence of causal associations.

Introdução: Nos contextos de conflito armado, convergem atividades que podem potencialmente produzir toxicidade por metais pesados; Na verdade, muitas vítimas de dispositivos explosivos improvisados carregam lascas residuais internalizadas de composição desconhecida e potencial toxicidade. Isto tem sido pouco estudado. Objetivo: Descrever os níveis biológicos de chumbo e mercúrio em civis sobreviventes do massacre de Bojayá, sua eventual exposição atual, bem como sinais e sintomas compatíveis com toxicidade crônica. Metodologia: Estudo observacional descritivo, tipo série com 13 casos. Resultados: 38.46 % dos casos apresentaram níveis de chumbo no sangue superiores ou próximos ao valor limite superior, sem fontes específicas identificadas. 46.15 % apresentaram níveis de mercúrio superiores ou próximos ao limite de referência e são considerados exposição ambiental devido à mineração regional de ouro. A avaliação clínica toxicológica mostrou sintomas e sinais clínicos potencialmente associados à toxicidade crônica por metais. Conclusão: Houve presença de resíduos de artefatos explosivos em pessoas com achados sugestivos de toxicidade por chumbo ou mercúrio, sem que se pudesse afirmar uma relação direta e específica entre os dois aspectos; Alguns casos sugerem exposição ambiental ao mercúrio e exposição a projéteis de chumbo, relacionadas com a dinâmica do conflito armado. Estudos adicionais são necessários para confirmar a existência de associações causais.

Efectos de la marihuana en la salud bucal / Effects of marijuana on oral health

Aun cuando las autoridades del Sector Salud en México no se han declarado respecto al uso medicinal de la marihuana, con el objetivo de conocer el estado actual internacional sobre sus riesgos y usos terapéuticos, investigamos los avances reportados en la actualidad, así como las comunidades que han despenalizado su uso. Se presenta su origen como elemento terapéutico, pueblos involucrados, diversas denominaciones, historicidad, las diversas preparaciones, farmacodinamia, sus efectos nocivos a la salud en general y particularmente en boca, sus posibles usos en odontología tomando en cuenta sus propiedades terapéuticas. ampliamente reseñadas en relación a otros lugares del organismo. Finalmente, la propuesta de investigación en odontología con especial énfasis en aquellas especialidades donde la inflamación y el dolor agudo estén presentes de manera significativa (AU)

Although health authorities in Mexico have not officially declared their stance on the medicinal use of marijuana, our research aims to explore the current international status regarding its risks and therapeutic uses. We have investigated the latest reported advancements and examined communities that have decriminalized its usage. This presentation encompasses its therapeutic origin, involved communities, various designations, historical context, diverse preparations, pharmacodynamics, its adverse effects on overall health and particularly oral health, as well as its potential applications in dentistry, considering its widely documented therapeutic properties in comparison to other areas of the body. Finally, our research proposal in dentistry places special emphasis on specialties where inflammation and acute pain are significantly present (AU)

Sulfato de magnesio y aminofilina en el tratamiento de niños, niñas y adolescentes hospitalizados. Perfil de uso y respuesta terapéutica

Introducción: Sulfato de magnesio (MgSO4) y aminofilina son broncodilatadores intravenosos utilizados en el tratamiento de niños con broncoobstrucción (BO). La evidencia disponible para recomendar su uso es escasa. Objetivo: Caracterizar el perfil de uso y la respuesta terapéutica al MgSO4 y aminofilina en el tratamiento de la BO en niños hospitalizados en un centro de referencia de Uruguay. Materiales y métodos: Estudio descriptivo de corte transversal mediante revisión de historias y entrevistas. Se incluyeron a todos los menores de 15 años que utilizaron estos fármacos. Se evaluó la respuesta terapéutica a la administración de ambos fármacos en forma exclusiva y concomitante y la presencia de efectos adversos. Resultados: Se incluyeron 102 niños, mediana de edad 4 años, ≤5 años 62%. Los principales diagnósticos fueron: crisis asmática 56% y neumonía viral 31%. Recibieron ambos fármacos 48%, únicamente aminofilina 28% y exclusiva de MgSO4 24%. Se observó buena respuesta terapéutica a la administración: exclusiva de MgSO4 67%, consecutiva de MgSO4 y aminofilina 45% y exclusiva de aminofilina en 34%. En 38,2% se registró al menos un efecto adverso, 64% eran menores de 5 años, riesgo aumentado en 1,5 veces. Conclusiones: Se registraron variadas indicaciones, la mayoría en niños asmáticos y en un porcentaje menor indicaciones fuera de prospecto. Menos de la mitad presentaron buena respuesta luego de la administración de MgSO4 y/o aminofilina. En un porcentaje no despreciable se registraron efectos adversos, predominaron en menores de 5 años. Son necesarios nuevos estudios para continuar caracterizando el perfil de uso y seguridad de estos fármacos.

Introduction: Magnesium sulfate (MgSO4) and aminophylline are intravenous bronchodilators used in the treatment of children with bronchoobstruction (BO). The evidence available to recommend their use is scarce. Objective: To characterize the use profile and therapeutic response to MgSO4 and aminophylline in the treatment of BO in children hospitalized in a reference center in Uruguay. Materials and methods: This was a descriptive cross-sectional study through review of clinical histories and interviews. All children under 15 years of age who used these drugs were included. The therapeutic response to the administration of both drugs exclusively and concomitantly and the presence of adverse effects were evaluated. Results: 102 children were included, median age was 4 years, 62% were ≤5 years. The main diagnoses were: asthmatic crisis, 56% and viral pneumonia, 31%. 48% received both drugs, 28% only aminophylline and 24% exclusively MgSO4. Good therapeutic response was observed to the administration: MgSO4 exclusively, 67%, MgSO4 followed by aminophylline, 45% and aminophylline exclusively in 34%. At least one adverse effect was recorded in 38.2%, of these, 64% were under 5 years of age, risk increased by 1.5 times. Conclusions: Various indications were recorded, the majority in asthmatic children and a smaller percentage off-label indications. Less than half had a good response after the administration of MgSO4 and/or aminophylline. Adverse effects were recorded in a non-negligible percentage, predominating in children under 5 years of age. New studies are necessary to continue characterizing the use and safety profile of these drugs.

Manejo dos eventos adversos do dupilumabe na dermatite atópica e no prurigo nodular / Management of the adverse effects of dupilumab in atopic dermatitis and prurigo nodularis

A dermatite atópica (DA) e o prurigo nodular (PN) são doenças inflamatórias da pele que cursam com lesões variadas, como eczemas, pápulas e nódulos, acompanhados de intenso prurido e, nos casos graves, de importante prejuízo da qualidade de vida para os pacientes e seus familiares. O dupilumabe está aprovado no Brasil para o manejo das duas condições: DA moderada/grave e PN que não responde aos tratamentos tópicos. A eficácia e segurança do dupilumabe foram amplamente estabelecidas para ambas as condições em ensaios clínicos e estudos de vida real. Este artigo tem como objetivo revisar os principais eventos adversos (EAD) associados ao uso do dupilumabe em DA e PN, e auxiliar no seu manejo. Desde o início do uso da medicação, há alguns anos, os principais EAD reportados foram: a reação no local da injeção, a doença da superfície ocular (conjuntivite não infecciosa, blefarite, olhos secos), a eosinofilia e o eritema de face/pescoço. Outras manifestações também foram observadas em pacientes com DA em uso de dupilumabe, mas sem associação comprovada: psoríase, artralgia e alopecia areata. Apesar de muito infrequentemente levarem à suspensão do dupilumabe, é fundamental que os médicos prescritores deste medicamento para estas condições, dermatologistas e imunoalergistas, saibam detectar e manejar seus possíveis eventos adversos.

Atopic dermatitis (AD) and prurigo nodularis (PN) are inflammatory skin diseases characterized by various lesions such as eczema, papules, and nodules, with marked pruritus and, in severe cases, significant impairment of quality of life for patients and their families. Dupilumab is approved in Brazil for the management of both moderate/severe AD and PN that does not respond to topical treatments. The efficacy and safety of dupilumab have been extensively established for both conditions in clinical trials and real-world studies.This article aims to review the main adverse events (AEs) associated with the use of dupilumab in AD and PN and assist in their management. Since the introduction of dupilumab a few years ago, the main reported AEs have been injection site reactions, ocular surface disease (non-infectious conjunctivitis, blepharitis, dry eyes), eosinophilia, and facial/neck erythema. Other manifestations have also been observed in patients with AD on dupilumab, but without proven association: psoriasis, arthralgia, and alopecia areata. Although AEs very infrequently lead to discontinuation of dupilumab, it is crucial that physicians prescribing it for these conditions, dermatologists, and immunologists know how to detect and manage its possible adverse effects.

Cánula Nasal de Alto Flujo Asimétrica: una Revisión Narrativa / Asymmetrical High Flow Nasal Cannula: a Narrative Review

Los sistemas de Cánula nasal de alto flujo (CNAF) han sido ampliamente utilizados en el campo clínico como soporte no invasivo en el manejo de la falla respiratoria aguda (sobre todo hipoxémica) y cuidados post extubación. Clínica y fisiológicamente, las cánulas nasales de alto flujo son capaces de entregar un flujo de oxigeno alto que, debido a que ese gas se encuentra optimamente humidificado y calefaccionado, permite una mejor tolerancia por parte del paciente al ser comparada con las cánulas de oxigeno tradicionales. Por otra parte, este alto. Flujo es capaz de generar una presión positiva al final de la espiración (CPAP) en la vía área y favorecer tanto en barrido de dióxido de carbono (CO2) desde la vía aérea superior, lo que disminuye el trabajo respiratorio del paciente y mejora su confort.. Sin embargo; aún existe un alto porcentaje de pacientes que fracasan la terapia con CNAF y requiere soportes mas complejos como la ventilación mecánica, ya sea imvasiva o no. Estos resultados con la terapia CNAF pueden ser influidos por aspectos técnicos como, por ejemplo, la turbulencia que pueden generar estos sistemas a nivel de la región nasal. Por esta razón se han desarrollado nuevas tecnologías en el diseño y uso de interfaces para suministrar este alto flujo. Una de estas innovaciones es el uso de cánulas asimétricas, las que potencian los beneficios fisiológicos que entrega una cánula de alto flujo convencional. La presente revisión pretende exponer las principales diferencias que presenta el sistema de alto flujo convencional versus la nueva interface asimétrica.

High-flow nasal cannula (HFNC) systems have been widely used in the clinical field as non-invasive support in the management of acute respiratory failure (especially hypoxemic) and post-extubation care. Clinically and physiologically, high flow nasal cannulas are capable of delivering a high flow of oxygen which, because this gas is optimally humidified and heated, allows better tolerance by the patient when compared to traditional oxygen cannulas. . On the other hand, this high. Flow is capable of generating positive pressure at the end of expiration (CPAP) in the airway and favoring the sweep of carbon dioxide (CO2) from the upper airway, which reduces the patient's respiratory work and improves their comfort. .. However; There is still a high percentage of patients who fail therapy with HFNC and require more complex supports such as mechanical ventilation, whether invasive or not. These results with HFNC therapy can be influenced by technical aspects such as, for example, the turbulence that these systems can generate in the nasal region. For this reason, new technologies have been developed in the design and use of interfaces to provide this high flow. One of these innovations is the use of asymmetric cannulas, which enhance the physiological benefits provided by a conventional high-flow cannula. The present review aims to expose the main differences that the conventional high flow system presents versus the new asymmetric interface.

Percepção dos profissionais de enfermagem sobre manejo de reação infusional a antineoplásicos: estudo qualitativo / Perception of nursing professionals on the management of infusion reactions to antineoplastics: qualitative study

Identificar a percepção dos profissionais de enfermagem sobre o manejo de reação infusional imediata a antineoplásicos. Método: Trata-se de um estudo descritivo de caráter exploratório com abordagem qualitativa realizado em um hospital no Rio Grande do Sul. Resultados: Todos os participantes afirmaram saber identificar uma reação infusional. Após a identificação da reação, nota-se que a maioria obedeceu a uma ordem de condutas a serem realizadas. Quanto aos cuidados para prevenção das reações infusionais, a maioria dos participantes mencionou a administração de medicamentos pré-quimioterápicos, como antialérgicos e antieméticos. Conclusão: Os achados demonstram que a maioria dos profissionais sabe reconhecer e manejar, porém há a necessidade de treinamentos e padronização das ações.(AU)

To identify the perception of nursing professionals about the management of immediate infusion reactions to antineoplastic drugs. Method: This is a descriptive, exploratory study with a qualitative approach carried out in a hospital in Rio Grande do Sul. Results: All the participants said they knew how to identify an infusion reaction. After identifying the reaction, it was noted that the majority followed an order of conduct to be carried out. As for precautions to prevent infusion reactions, most of the participants mentioned the administration of pre-chemotherapy drugs, such as anti-allergic and anti-emetic drugs. Conclusion: The findings show that most professionals know how to recognize and manage them, but there is a need for training and standardization of actions.(AU)

Identificar la percepción de los profesionales de enfermería sobre el manejo de las reacciones infusionales inmediatas a medicamentos antineoplásicos. Método: Se trata de un estudio descriptivo, exploratorio, con abordaje cualitativo, realizado en un hospital de Rio Grande do Sul. Resultados: Todos los participantes afirmaron saber identificar una reacción a la infusión. Después de identificar la reacción, la mayoría siguió un orden de conducta. En cuanto a las precauciones para prevenir las reacciones a la infusión, la mayoría de los participantes mencionó la administración de fármacos prequimioterápicos, como antialérgicos y antieméticos. Conclusión: Los hallazgos muestran que la mayoría de los profesionales saben reconocerlas y manejarlas, pero es necesaria la formación y la estandarización de actuaciones.(AU)

ACE gene polymorphisms (rs4340) II and DI are more responsive to the ergogenic effect of caffeine than DD on aerobic power, heart rate, and perceived exertion in a homogeneous Brazilian group of adolescent athletes

The purpose of this study was to verify the association between angiotensin-converting enzyme (ACE) genotypes DD, DI, and II and caffeine (CAF) ingestion on endurance performance, heart rate, ratio of perceived exertion (RPE), and habitual caffeine intake (HCI) of adolescent athletes. Seventy-four male adolescent athletes (age: DD=16±1.7; DI=16±2.0; II=15±1.7 years) ingested CAF (6 mg/kg) or placebo (PLA) one hour before performing the Yo-Yo Intermittent Recovery level 1 (Yo-Yo IR1) test. No difference was found among groups for HCI. However, CAF increased the maximal distance covered and VO2max in DI and II genotype carriers compared to PLA (DD: Δ=31 m and 0.3 mL·kg-1·min-1; DI: Δ=286 m and 1.1 mL·kg-1·min-1; II: Δ=160 m and 1.4 mL·kg-1·min-1). Heart rate of DI and II genotype carriers increased with CAF compared to PLA, while RPE was higher in the II and lower in the DD genotypes. The correlations between HCI and maximal distance covered or VO2max were significant in the II genotype carriers with CAF. CAF increased endurance capacity, heart rate, and RPE in adolescent athletes with allele I, while endurance performance and aerobic power had a positive correlation to HCI in the II genotype group. These findings suggested that DD genotype were less responsive to CAF and that genetic variations should be taken into account when using CAF supplementation to enhance exercise performance.

Necrólisis epidérmica tóxica debido a un fármaco a base de caléndula más acetilcisteína: presentación de caso / Toxic Epidermal Necrolysis Induced by a Drug Combination of Calendula and Acetylcysteine: A Case Report / Necrólise epidermal tóxica por medicamento à base de calêndula mais acetilcisteína: relato de caso

Introducción: la hipersensibilidad por fármacos es inducida por una respuesta aberrante del sistema inmune; por lo general, impredecible, dosis independiente y amenazante para la vida del paciente. Las reacciones de hipersensibilidad por fármacos con compromiso mucocutáneo se dan en alrededor del 2 %-3 % de los pacientes hospitalizados. Objetivo: describir un caso de necrólisis tóxica epidérmica por un fármaco a base de caléndula y acetilcisteína como los presuntos desencadenantes. Presentación del caso: hombre de 39 años, quien asistió a emergencias, por malestar general, artralgias, mialgias, astenia y adinamia de un día de evolución. Tres días después refirió la aparición de lesiones purpúricas progre-sivas que se extendieron por cara, extremidades y glúteos; delimitadas; no dolorosas, y sin desaparecer a la digitopresión, asociado con disnea, inestabilidad hemodinámica y cardiovascular. Al sexto día de hos-pitalización, se interrogó al paciente, quien se había automedicado un fármaco de origen desconocido, presuntamente de extracto herbal a base de caléndula más acetilcisteína para artralgias, osteomialgias y disfagia. A la mañana siguiente, presentó lesiones purpúricas y ulcerativas extensas. Se observaron lesiones purpúricas progresivas y ulcerativas en cara extremidades y glúteos. Mediante la sospecha clínica y la evaluación histopatológica, se confirmó la necrólisis tóxica epidérmica. Conclusiones: las reacciones adversas medicamentosas severas que amenazan la vida del paciente son relativamente raras, pero representan un verdadero desafío diagnóstico y terapéutico. Es necesario profundizar en la investigación para esclarecer la causa de este tipo de reacción medicamentosa.

Introduction: Drug hypersensitivity is induced by an aberrant response from the immune system. It is usually unpredictable, dose-independent, and can be life-threatening to the patient. Drug-induced hypersensitivity reactions with mucocutaneous involvement occur in approximately 2­3% of hospitalized patients. However, Toxic Epidermal Necrolysis is a rare case. Aim: To describe a case of drug-induced toxic epidermal necrolysis triggered by Calendula officinalis and acetylcysteine. Case report: A 39-year-old male was pre-sented to the emergency room with malaise, arthralgia, myalgia, asthenia, and adynamia since day one. Three days later, he developed progressive purpuric lesions that spread to the face, extremities, and buttocks. These lesions were painless, not delineate, and did not blanch under pressure. They were asso-ciated with dyspnea and hemodynamic and cardiovascular instability. On the sixth day of hospitaliza-tion, the patient admitted to self-medicating with an unknown drug, presumably a herbal extract based on calendula and acetylcysteine, for arthralgia, myalgia, and dysphagia. The morning after the drug consumption, the patient developed extensive purpuric and ulcerative lesions. A diagnosis of toxic epi-dermal necrolysis was made based on clinical suspicion and histopathological confirmation. Conclusion:Severe adverse drug reactions that threaten a patient's life are relatively rare. However, they represent a real diagnostic and therapeutic challenge when they do occur

Introdução: a hipersensibilidade a drogas é induzida por uma resposta aberrante do sistema imunoló-gico; geralmente imprevisível, independente da dose e com risco de vida para o paciente. As reações de hipersensibilidade a drogas com comprometimento mucocutâneo estão em torno dos 2-3% dos pacien-tes hospitalizados. Objetivo: descrever um caso de necrólise epidérmica tóxica causada por uma droga à base de Calendula officinalis e acetilcisteína como os supostos desencadeantes. Apresentação do caso:homem, 39 anos, deu entrada no pronto-socorro manifestando mal-estar, artralgia, mialgia, astenia e adinamia há um dia. Posteriormente, três dias depois, relatou o aparecimento de lesões purpúricas pro-gressivas que se espalharam para a face, extremidades e nádegas; que são delimitadas, não dolorosas e não desaparecem com a acupressão associada a dispnéia, instabilidade hemodinâmica e cardiovascular. No sexto dia de internação, o paciente foi questionado, y disse que tinha se automedicado com uma droga de origem desconhecida, presumivelmente extrato de ervas à base de calêndula mais acetilcis-teína para artralgia, osteomialgia e disfagia. Na manhã seguinte, apresentou extensas lesões purpúricas e ulcerativas. Observam-se lesões purpúricas progressivas e ulcerativas que se estendem à face, extre-midades e nádegas. Pela suspeita clínica e confirmação histopatológica, confirma-se a necrólise epidér-mica tóxica. Conclusões: reações adversas graves a medicamentos que ameaçam a vida do paciente são relativamente raras, mas quando ocorrem representam um verdadeiro desafio a nível diagnóstico e terapêutico. São precisas mais pesquisas para esclarecer a causa desse tipo de reação medicamentosa.

Gastroparesia severa asociada al uso de agonistas del receptor GLP-1 para bajar de peso / Severe gastroparesia associated with the use of GLP-1 receptor agonists for weight loss

RESUMEN Inicialmente desarrollados como medicamentos para la diabetes mellitus, los agonistas GLP-1 han ganado mucha popularidad en el tratamiento de la obesidad y la pérdida de peso. El presente caso describe a una mujer de 69 años con antecedente de úlcera péptica y consumo de AINES, quien cursó con dolor abdominal e intolerancia oral refractaria al manejo convencional, por lo que se realizó una endoscopía digestiva alta, diagnosticándose gastroparesia severa. Al ampliar la anamnesis, se reveló el uso subrepticio de semaglutida. Se continuó con terapia de soporte y los síntomas remitieron espontáneamente. El presente reporte de caso tiene como objetivo advertir los riesgos potenciales del uso de análogos de GLP-1 en el contexto de una endoscopía con sedación.

ABSTRACT Initially developed as medications for diabetes mellitus, GLP-1 agonists have gained much popularity in the treatment of obesity and weight loss. The present case describes a 69-yearold woman with a history of peptic ulcer and use of NSAIDs, who presented with abdominal pain and oral intolerance refractory to conventional management, for which an upper digestive endoscopy was performed, diagnosing severe gastroparesis. Asking more about the story, revealed surreptitious use of semaglutide. She continued with supportive therapy and the symptoms resolved spontaneously. The present case report aims to warn of the potential risks of the use of GLP-1 analogues in the context of endoscopy with sedation.

Reviews and Recommendations in Comparative Studies on Quality of Wild and Cultivated Chinese Crude Drugs / 中国实验方剂学杂志

By reviewing the research history on quality comparison between wild and cultivated Chinese crude drugs， this paper systematically combed the relevant research reports since the 1950s， and summarized and analyzed the results of existing comparative studies， and found that the existing comparative research on the quality of wild and cultivated Chinese crude drugs were mainly focused on several aspects， including characteristics， microstructures， chemical compositions， pharmacodynamic effects， and genetic diversity. Among these， comparative studies of chemical compositions have been the dominant approach， with a particular emphasis on comparing the contents of index components. However， research on pharmacodynamic effects remained relatively limited. Due to various factors such as sample quantity， sample origin， growth period and cultivation methods， the differences in quality between wild and cultivated Chinese crude drugs vary significantly. In general， most wild Chinese crude drugs exhibited higher quality than cultivated products， with significant differences in their characteristics. The contents and proportions of some chemical components underwent noticeable changes， particularly with a marked increase in the proportion of primary metabolites after cultivation. The quality of cultivated Chinese crude drugs is closely related to the cultivation practices employed. Chinese crude drugs produced through wild nurturing， simulated wild planting， ecological cultivation， and other similar methods demonstrate quality levels comparable to those of wild Chinese crude drugs. Based on the analysis results， it is recommended to explicitly specify the cultivation practices and cultivation period of cultivated Chinese crude drugs in comparative studies of the quality between wild and cultivated Chinese crude drugs. Multiple technical approaches， including characteristics， microscopy， non-targeted metabolomics combined with quantitative analysis of differential components， and bioefficacy evaluation， should be employed to comprehensively assess the quality disparities between wild and cultivated Chinese crude drugs. Moreover， research efforts should be intensified to investigate the changes in pharmacodynamic effects resulting from differences in plant cell wall composition， primary metabolites， and secondary metabolites， in order to guide the production of high-quality Chinese crude drugs.

Chemical components in cultivated Cordyceps sinensis and their effects on fibrosis / 中草药·英文版

OBJECTIVE@#Cultivated Cordyceps sinensis powder has been used as clinical drug and healthy food to nourish the lung and kidney, which solves the problem of serious shortage of wild C. sinensis. This study aims to explore the chemical components and compared their anti-fibrotic effects in cultivated C. sinensis.@*METHODS@#Nucleosides, sterols and polysaccharides were separated and purified from cultivated C. sinensis, and analyzed by high performance liquid chromatography, gas chromatography-mass spectrometry and chemical chromogenic methods, respectively. In high glucose-induced rat mesangial cell models, fibronectin and type 1 collagen were used as evaluation indicators.@*RESULTS@#There were 10 kinds of nucleosides and one sterol in cultivated C. sinensis. The contents of nucleosides, sterols and polysaccharides in the cultivated C. sinensis were close to 2%, 0.55% and 4.4%, respectively. Furthermore, nucleoside, sterol and polysaccharide components exhibited varying degrees of anti-fibrotic activity. The nucleoside components and sterol components inhibited the expression of extracellular matrix more effectively in the three main components.@*CONCLUSION@#Cultivated C. sinensis remains the similar compounds with the wild C. sinensis, and nucleosides and sterols may be the main active substances that contribute to its anti-fibrotic effects. The project of this study may provide valuable information on further optimization of more effective remedies with few side effects based on cultivated C. sinensis.

Research on the relationship between disease perception and demoralization of patients with chronic heart failure: the chain mediating effect of disease progression ′s fear and positive affect / 中国实用护理杂志

Objective:To explore the mediating role of disease progression′s fear and positive affect in the relationship between disease perception and demoralization in patients with chronic heart failure. It provided a theoretical basis for targeted interventions for healthcare workers.Methods:From October 2022 to March 2023, 320 patients with chronic heart failure in the First Affiliated Hospital of Zhengzhou University were selected as the research objects by convenience sampling. The General Information Questionnaire, Demoralization Scale Redacted Mandarin Version, Brief Illness Perception Questionnaire, Fear of Progression Questionnaire-Short Form, Positive and Negative Affect Schedule (Positive Affect Schedule) were used to conduct the questionnaire survey exploring the mediating effects of fear of disease progression and positive emotions between disease perception and disorientation by construction structural equation model.Results:There were 268 valid questionnaires. Of the 268 patients, 168 were male and 100 were female, 3.36% (9/268) were ≤40 years old, 55.22% (148/268) were 41-65 years old, and 41.42% (111/268) were >65 years old. Correlation analysis showed that disease perception was positively correlated with disease progression ′s fear, and every dimension of demoralization ( r values were 0.300-0.586, all P<0.01), and negatively correlated with positive affect ( r=-0.374, P<0.01); disease progression′s fear was negatively correlated with positive affect ( r=-0.318, P<0.01), and positively correlated with every dimension of demoralization ( r values were 0.339-0.464, all P<0.01); positive affect was negatively correlated with every dimension of demoralization ( r values were -0.430--0.334, all P<0.01). Structural equation model analysis showed that the direct effect of disease perception on demoralization was significant ( β=0.407, P<0.01), and both mediating effects of disease progression ′s fear and positive affect between disease perception and demoralization in patients with chronic heart failure were significant ( β=0.074, 0.079, both P<0.01). The chain mediating effect of disease progression ′s fear and positive effect was also significant ( β=0.019, P<0.01). Conclusions:Disease perception could directly predict the demoralization of patients with chronic heart failure and indirectly predict the demoralization of patients with chronic heart failure through the mediating effect of disease progression ′s fear, positive affect, and the chain mediating effect of disease progression ′s fear and positive affect.

Efficacy and safety of evolocumab in elderly patients with high-risk cardiovascular diseases / 中华老年心脑血管病杂志

Objective To explore the efficacy and safety of evolocumab in elderly patients with high-risk cardiovascular diseases.Methods A total of 153 patients with poor lipid control after conventional statin therapy who were hospitalized in the cardiologic departments in the First,Sec-ond,Sixth and Eighth Medical Centers of Chinese PLA General Hospital from November 2019 to November 2022 were included,and divided into non-elderly group(＜60 years old,46 cases),eld-erly group(60-74 years old,66 case)and very elderly group(≥75 years old,41 cases).They were all given evolocumab treatment according to guidelines.Another 50 over-75-year-old patients with high-risk cardiovascular diseases and poor lipid control who were hospitalized in the above cardiologic departments during the same period were treated with a statin drug combined with ezetimibe,and served as conventional treatment group(control group).The baseline clinical data and the blood indicators at 4th and 12th week after drug administration,and the occurrence of ad-verse drug reactions and major adverse cardiovascular events(MACE)within 12 weeks were com-pared among the groups.Results The levels of LDL-C and TC were significantly decreased in the three evolocumab treatment groups at 4 and 12 weeks after medication when compared with the baseline values(P＜0.05,P＜0.01),but there were no obvious differences in the 2 levels among the 3 groups at 12 weeks(P＞0.05).At the time point,no statistical difference was observed in the incidence of adverse events in the three groups(2.2％vs 3.0％vs 2.4％,P＞0.05).The levels of LDL-C and TC were decreased significantly in the very elderly group and the conventional treatment group at the 12th week when compared with the baseline levels(P＜0.05,P＜0.01),and the LDL-C level at the week was notably lower in the very elderly group than the convention-al treatment group(1.36±0.44 mmol/L vs 1.87±0.56 mmol/L,P＜0.01).But no difference was seen in the incidence of MACE between the 2 groups(12.2％vs 16.0％,P＞0.05),either in sur-vival rate between them(P=0.576).Conclusion For patients of all ages,evolocumab has good short-term efficacy in lipid control,and for those over 75 years old,the drug also shows good effi-cacy and sound safety.

Relationship between occupational coping self-efficacy and health-related productivity loss in ICU nurses： path analysis of perceived social support / 四川精神卫生

BackgroundCompared with absenteeism， health-related productivity loss has a long-lasting negative effect， and poses a greater harm and loss. The health-related productivity loss is mediated by self-efficacy， and perceived social support has been shown to have an impact on health-related productivity loss， whereas the interaction mechanism among the three remains unclear. ObjectiveTo investigate the status of perceived social support， occupational coping self-efficacy and health-related productivity loss among ICU nurses， and to test the mediation role of perceived social support in the relationship between occupational coping self-efficacy and health-related productivity loss. MethodsFrom September to November， 2021， purposive sampling technique was adopted to select 468 ICU nurses in 8 tertiary hospitals in Sichuan Province. Subjects were assessed using self-made general information questionnaire， Perceived Social Support Scale （PSSS）， Occupational Coping Self Efficacy Scale for Nurses （OCSE-N） and Stanford Presenteeism Scale-6 （SPS-6）. Pearson correlation analysis was used to examine the correlation among variables. Amos 24.0 was utilized to test the mediation role of perceived social support in the relationship between occupational coping self-efficacy and health-related productivity loss. ResultsA total of 415 ICU nurses completed the valid questionnaire survey. ICU nurses scored （63.13±11.62） on PSSS， （22.24±6.15） on OCSE-N， and （16.83±4.24） on SPS-6. Health-related productivity loss was detected in 279 ICU nurses （67.23%）. Correlation analysis denoted that PSSS total score was positively correlated with OCSE-N total score （r=0.348， P<0.05）， and negatively correlated with SPS-6 total score （r=-0.274， P<0.05）. OCSE-N total score was negatively correlated with SPS-6 total score （r=-0.421， P<0.05）. The direct effect value of occupational coping self-efficacy on health-related productivity loss was -0.401， and perceived social support showed a mediation role in the relationship between occupational coping self-efficacy and health-related productivity loss （the indirect effect value was -0.052， accounting for 11.48% of the total effect）. ConclusionThe occupational coping self-efficacy of ICU nurses may affect the health-related productivity loss through the action path of perceived social support.［Funded by Scientific Research Project of Sichuan Provincial Health Commission （number， 19PJ042）］

Impact of subjective vertical perception impairment on function in stroke patients: a retrospective study / 中国康复理论与实践

ObjectiveTo explore the impact of subjective vertical perception impairment after stroke on visuospatial cognition, balance, walking and activities of daily living, to investigate the mediating role of visuospatial cognition and lateropulsion. MethodsFrom February to December, 2023, 96 stroke patients were selected from the Rehabilitation Medicine Center of the First Affiliated Hospital of Nanjing Medical University. They were divided into vertical perception impairment group (n = 53) and non-vertical perception impairment group (n = 43). They were assessed with National Institutes of Health Stroke Scale (NIHSS), the Scale for Contraversive Pushing (SCP), Burke Lateropulsion Scale (BLS), Line Bisection Test (LBT), Line Cancellation Test (LCT), Star Cancellation Test (SCT), Subjective Visual Vertical (SVV), Berg Balance Scale (BBS), Holden Functional Ambulation Categories (FAC) and Barthel Index (BI). ResultsScores of SVV orientation, SVV uncertainty, NIHSS, SCT, SCP, BLS, BBS, FAC and BI were worse in the vertical perception impairment group than in the non-vertical perception impairment group (|t| > 2.414, Z = -3.481, P < 0.05). Scores of SVV were correlated with SCT, BLS and BBS (|r| ≥ 0.273, P < 0.05). After controlling for age and gender, SVV orientation score did not directly impact BBS score (β = -0.011, P = 0.920). However, it exerted a partial mediating effect through BLS (effect = -0.173, 95%CI -0.278 to -0.076) and a chain-mediated effect through SCT and BLS (effect = -0.073, 95%CI -0.137 to -0.027), impacting BBS score. ConclusionSubjective vertical perception impairment results in poorer visuospatial cognition, balance, walking and activities of daily living in stroke patients. This influence on balance function is mediated through the mediating effects of visuospatial cognition and lateropulsion.

Quercetin plays a neuroprotective role in inhibiting mitochondrial apoptosis by mediating JNK signaling pathway / 中国药理学通报

Aim To study the mechanism of quereetin (Que) inhibiting mitochondrial damage induced by Aβ

The value of NLR in predicting the efficacy of preoperative nimotuzumab combined with neoadjuvant chemotherapy for local advanced oral squamous cell carcinoma / 口腔疾病防治

Objective@#To investigate the value of the peripheral blood neutrophil to lymphocyte ratio (NLR) before nimotuzumab combined with neoadjuvant chemotherapy in predicting the short-term efficacy of neoadjuvant therapy for advanced oral squamous cell carcinoma (OSCC).@*Methods@#With the approval of the Ethics Committee and the informed consent of the patients, 59 patients with stage Ⅲ and Ⅳ OSCC who were admitted to the Oral and Maxillofacial Surgery Department of the First Hospital of Shanxi Medical University from September 2020 to June 2023 were enrolled. All the patients had complete clinical data, were pathologically diagnosed with squamous cell carcinoma, and received preoperative and received preoperative nimotuzumab + TP (docetaxel + cisplatin) neoadjuvant chemotherapy. The clinical data were analyzed, and the neutrophil and lymphocyte counts in peripheral blood were collected before and after nimotuzumab combined with neoadjuvant chemotherapy. The NLR was calculated, and the threshold value was calculated using the receiver operating characteristic (ROC) curve. Patients were divided into a high NLR group and a low NLR group according to the NLR threshold before nimotuzumab combined with neoadjuvant chemotherapy with TP. The clinical efficacy after nimotuzumab combined with neoadjuvant chemotherapy with TP was evaluated according to the evaluation criteria for solid tumor efficacy, and the correlation between the NLR and recent neoadjuvant therapy efficacy was analyzed. Immunohistochemical staining was used to detect the expression of epidermal growth factor receptor (EGFR) in OSCC tissues before and after nimotuzumab combined with neoadjuvant chemotherapy with TP and to analyze whether the expression of EGFR differed among the different NLR groups.@*Results@#A total of 59 patients with advanced OSCC were included. According to the ROC curve, the NLR threshold was 2.377, and the patients were divided into a <2.377 group (low NLR group), with 24 patients, and a>2.377 group (high NLR group), with 35 patients. The short-term neoadjuvant therapy effect was significantly greater in the lower NLR group than in the higher NLR group (P<0.05); EGFR expression in both the low NLR group and the high NLR group decreased after nimotuzumab combined with neoadjuvant chemotherapy with TP, and the decrease in the low NLR group was significantly greater than that in the high NLR group (P<0.05).@*Conclusion@#A low NLR before nimotuzumab combined with neoadjuvant chemotherapy with TP is associated with better neoadjuvant therapy outcomes, and such patients are more likely to benefit from preoperative nimotuzumab combined with neoadjuvant chemotherapy.

Effect of perioperative precision nursing intervention on elderly patients with femoral neck fractures / 现代医院

Objective To investigate the impact and significance of a precision nursing plan during the surgical manage-ment of femoral neck fractures in elderly patients.Methods From May 2022 to May 2023,70 patients with femoral neck frac-tures,including medium-sized neck and head-type,were randomly divided into a control group and an observation group equally.The two groups were managed with routine nursing interventions and specific nursing interventions,respectively.The two groups were compared in terms of the psychological status,complications,hip joint functions,and prognostic effects.Results After the intervention,the psychological status scores of both two groups significantly decreased.The observation group showed lower psy-chological status scores,indicating better psychological status compared to the control group(P＜0.05).The rate of postopera-tive complications in the observation group was significantly lower than that of the control group(P＜0.05).Additionally,the scores of hip joint function in the observation group were higher than those of the control group(P＜0.05).At the time of dis-charge,the scores of self-care ability in both two groups had increased,and the scores of femoral head necrosis were significantly decreased after 3 months of interventions(P＜0.05).Furthermore,the self-care ability scores in the observation group were higher,and the scores of femoral head necrosis were lower compared to those of the control group,indicating that the prognosis of the observation group was better than that of the control group(P＜0.05).Conclusion The precise nursing interventions could effectively enhance the prognosis of elderly patients with femoral neck fractures and improve their self-care ability.

Mechanism of obesity in the occurrence and development of gastroesophageal reflux disease / 中华消化外科杂志

Obesity is one of the main risk factors for gastroesophageal reflux disease (GERD). With the development of social economy, the global obesity population shows a continuous growth trend, leading to an increase in the incidence rate of GERD. Obesity, especially the central obesity, is closely related to GERD. The increase of intra-abdominal pressure caused by obesity may lead to the destruction of "anti-reflux barrier" through a variety of mechanical mechanisms, and the various cytokines produced by visceral adipose tissue in obesity population may contribute to the occurr-ence and development of GERD through various biological effects. The authors explore the mechanism of obesity in the occurrence and development of GERD from both mechanical and biological effects, aiming to help clinical physicians improve their understanding of GERD.