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2.
BMC Public Health ; 20(1): 618, 2020 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-32370787

RESUMO

BACKGROUND: A maintained psychological wellbeing is important in order to continue working longer and remain active into older age. However, little is known about impact of different organizational factors, such as downsizing, on the mental health of older workers exiting the labor market. The aim in this study was to investigate trajectories of purchases of psychotropic drugs in relation to labor market exit later in life in a context with and without downsizing. METHOD: People living in Sweden, born 1941-1951, exiting paid work via unemployment, sickness absence/disability pension, or old-age pension were followed from 2005 to 2013 regarding purchases of psychotropic drugs. Individuals employed at a workplace closing down or downsizing with ≥18% between two subsequent years were compared to employees exiting from workplaces without downsizing or workplace closure. Generalized estimating equations was applied to derive trajectories of annual prevalence of purchased antidepressants, sedatives and anxiolytics from 4 years before to 4 years after a labour market exit. RESULTS: During the period around the exit, old-age retirees experiencing a downsizing/workplace closure did not decrease their purchases of sedatives (OR 1.01 95% CI 0.95-1.07) while the unexposed decreased their purchases during this period (OR 0.95 95% CI 0.92-0.98). Similar differences concerning sedatives and antidepressants between exposed and unexposed were seen for those exiting via sickness absence or disability pension. Furthermore, a significant difference in purchases of anxiolytics was observed between those exposed to downsizing (OR 1.10 95% CI 0.97-1.24) and the unexposed (OR 0.98 95% CI 0.91-1.06) exiting via old-age retirement during the time before the exit. CONCLUSION: Downsizing or workplace closure, although weakly, was associated with higher prevalence of psychotropic drugs certain years around the labor market exit. The results support the idea that involuntary labor market exit in mature adulthood may negatively affect the development of mental health.


Assuntos
Depressores do Sistema Nervoso Central/administração & dosagem , Pensões/estatística & dados numéricos , Aposentadoria/estatística & dados numéricos , Desemprego/estatística & dados numéricos , Ansiolíticos/uso terapêutico , Antidepressivos/uso terapêutico , Depressores do Sistema Nervoso Central/uso terapêutico , Pessoas com Deficiência , Emprego/psicologia , Feminino , Humanos , Hipnóticos e Sedativos/uso terapêutico , Estudos Longitudinais , Masculino , Saúde Mental , Pessoa de Meia-Idade , Ocupações , Inovação Organizacional , Estudos Prospectivos , Aposentadoria/psicologia , Suécia , Desemprego/psicologia , Local de Trabalho
3.
Public Health Rep ; 135(3): 383-392, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32311304

RESUMO

OBJECTIVE: The opioid epidemic in the United States increasingly affects women of reproductive age and has resulted in a rise in concurrent polydrug use. The objective of this study was to investigate the effect of this polydrug use on preterm birth in a multiethnic birth cohort. METHODS: We analyzed data from 8261 mothers enrolled in the Boston Birth Cohort from 1998 to 2018 in Boston, Massachusetts. We grouped substances used during pregnancy based on their primary effects (stimulant or depressant) and assessed independent and combined associations with smoking on preterm birth. RESULTS: Of 8261 mothers, 131 used stimulant drugs and 193 used depressant drugs during pregnancy. The preterm birth rate was 27.5% (2271 of 8261) in the sample. Mothers who smoked had 35% increased odds of preterm birth across adjusted models. Mothers who used stimulant drugs without smoking were not at increased risk of preterm delivery compared with mothers who used neither (odds ratio [OR] = 0.69; 95% confidence interval [CI], 0.19-1.98), whereas mothers who used depressant drugs without smoking had more than twice the odds of having preterm delivery (OR = 2.31; 95% CI, 1.19-4.44), and infants were at risk of a 1-week reduction in gestational age (OR = -1.05; 95% CI, -2.07 to -0.03). Concurrently smoking and using depressant drugs was associated with increased odds of preterm birth (OR = 1.83; 95% CI, 1.28-2.61), as was concurrently smoking and using stimulant drugs (OR = 1.73; 95% CI, 1.14-2.59). CONCLUSIONS: Using stimulant drugs and depressant drugs during pregnancy is a risk factor for preterm birth. The individual and combined effects of using these drugs with smoking must be considered together to reduce the risk of preterm birth in the United States.


Assuntos
Nascimento Prematuro/etnologia , Transtornos Relacionados ao Uso de Substâncias/etnologia , Adulto , Boston , Depressores do Sistema Nervoso Central/administração & dosagem , Estimulantes do Sistema Nervoso Central/administração & dosagem , Grupos Étnicos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Razão de Chances , Pobreza , Gravidez , Nascimento Prematuro/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/etnologia , Fatores de Risco , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Fumar Tabaco/etnologia , Estados Unidos , Adulto Jovem
4.
Georgian Med News ; (299): 87-93, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32242852

RESUMO

In recent years, there has been a progressive increase in the number of patients with chronic kidney disease (CKD), whose mortality risk is significantly higher than in general patients, which is associated with cardiovascular risks.In patients with CKD stage 5D before the start of replacement renal therapy for hypertension exceeds 90%. The aim -to analyze the efficacy and safety of the use of melatonin in the complex treatment of arterial hypertension (AH) in patients with CKD of 5 stage with impaired melatonin-forming function of the epiphysis (MFE). 60 people (35 women and 25 men) with a chronic kidney disease of 5 stage, which have violated MFE and AH were examined. For all patients in addition to antihypertensive therapy were prescribed the drug melatonin at a dose of 3 mg, which was taken once a day at 22:00 for 8 weeks. For all examined, before and after the course of treatment, were measured blood pressure (BP), Ambulatory Blood Pressure Monitoring (ABPM) and determination of the concentration of melatonin in the salivaby immunosorbent method. The examined patients showed a high frequency of MFE disturbance both in the daytime and at night - respectively, in 52,4% (p<0,001) and 82,6% (p<0,001). The dynamics of the diurnal BP on the background of treatment was due to changes in the degree of nocturnal decrease of BP, the number of patients in the main group with the "non-dipper" profile, decreased from 44,5% to 27,6% (p<0,05%), the proportion of patients with a daily profile of BP "night-peakear" from 22,4% to 4,8% (p<0,05%). Besides, a statistically significant of the number of persons with a daily profile of BP "dipper" increase in 30,2%. Against the background of complex treatment, there was a decrease in the patient's need for the dose and amount of antihypertensive drugs to achieve BP targets. Our data show a high incidence of MFE disorders in patients with CKD stage VD, and adding to the antihypertensive therapy of the drug melatonin in patients with CKD of 5 stage is effective and safe.


Assuntos
Hipertensão/tratamento farmacológico , Melatonina/uso terapêutico , Insuficiência Renal Crônica/complicações , Anti-Hipertensivos , Antioxidantes/uso terapêutico , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Depressores do Sistema Nervoso Central/uso terapêutico , Doença Crônica , Ritmo Circadiano , Feminino , Humanos , Hipertensão/complicações , Falência Renal Crônica/fisiopatologia , Masculino , Insuficiência Renal Crônica/fisiopatologia , Fatores de Risco , Fatores de Tempo
5.
BMC Infect Dis ; 20(1): 196, 2020 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-32138757

RESUMO

BACKGROUND: Few data are available regarding the use of direct antiviral agents (DAAs) for chronic hepatitis C in psychiatric patients. The aim of the study is to assess safety and outcome of DAAs in patients with psychiatric comorbidities. METHODS: This retrospective, observational, single-centre study enrolled patients treated with psychiatric drugs who initiated DAAs between 2015 and 2018. Patients were classified into two groups: A (on anxiolitycs/antidepressant) and B (on antipsychotics). Week-12 sustained virological response (SVR-12) and adverse events (AEs) were evaluated. RESULTS: One hundred forty-four patients were included (A:101; B:43). Patients were 49.3% males, mean age 60 years (SD ± 13.5); 31.9% cirrhotic; 125 (86.8%) HCV-monoinfected and 19 (13.2%) HCV /HIV-coinfected. Twenty patients (13.8%) required a change of psychiatric therapy before initiation of DAA. Overall, SVR-12 was achieved in 88.2% of subjects in intention-to-treat(ITT)-analysis. Lower SVR rates were observed in group B vs A (79% vs 92%, p = 0.045) and in those changing psychiatric drugs vs others (8% vs 30%, p = 0.015). According to per-protocol (PP)-analysis, SVR-12 was achieved in 93/95 (97.9%) in group A versus 34/36 (94.4%) in group B (p = 0.30). At least one AE occurred in 60 patients (41.6%), including 10 severe AEs, leading to 3 discontinuations. AEs were more frequently reported in group A (p = 0.015). CONCLUSIONS: The study confirms effectiveness and safety of DAA-based treatment also in this special population, even if a careful evaluation of history and drug-drug interactions is warranted.


Assuntos
Antivirais/uso terapêutico , Coinfecção/tratamento farmacológico , Infecções por HIV/tratamento farmacológico , Hepatite C Crônica/tratamento farmacológico , Transtornos Mentais/tratamento farmacológico , Idoso , Antivirais/efeitos adversos , Depressores do Sistema Nervoso Central/efeitos adversos , Depressores do Sistema Nervoso Central/uso terapêutico , Coinfecção/epidemiologia , Comorbidade , Interações Medicamentosas , Quimioterapia Combinada , Feminino , Infecções por HIV/epidemiologia , Hepatite C Crônica/epidemiologia , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Resposta Viral Sustentada
6.
J Forensic Leg Med ; 69: 101890, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32056808

RESUMO

This retrospective study sought to identify a regular pattern of limb bruising which occurs in association with suicidal or accidental hanging. Following exclusion of cases suspicious for homicide, 82 consecutive cases of hanging from a 10-year period were retrospectively reviewed to identify the pattern of traumatic limb injury in each case. Relevant information such as location, toxicology, and type of suspension was also noted. 72% of the reviewed cases had traumatic limb lesions, the majority of which occurred on the posterior upper limb and the anterior lower limb. Although the distribution of limb injury in our study mirrored that found in the literature, the incidence is much higher than in previous studies (7.4-20%). This could either be due to differences in confounding factors such as intoxication and location of hanging or differences in the practice of recording of limb trauma in hanging between centres. Neither type of suspension nor location of hanging were significantly associated with an increased incidence of traumatic limb injury. Positive toxicology was found to increase the likelihood of sustaining limb injury (p = .044084). In conclusion, the presence of this well documented pattern of traumatic limb lesions in cases of hanging should not always raise suspicion of foul play.


Assuntos
Asfixia/patologia , Extremidade Inferior/lesões , Lesões do Pescoço/patologia , Extremidade Superior/lesões , Adulto , Distribuição por Idade , Asfixia/mortalidade , Depressores do Sistema Nervoso Central/sangue , Depressores do Sistema Nervoso Central/urina , Etanol/sangue , Etanol/urina , Feminino , Ciências Forenses , Humanos , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/mortalidade , Preparações Farmacêuticas/sangue , Estudos Retrospectivos , Distribuição por Sexo , Detecção do Abuso de Substâncias , Suicídio Consumado , Extremidade Superior/patologia , Adulto Jovem
7.
Am J Forensic Med Pathol ; 41(1): 18-26, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32000223

RESUMO

The suicide rate in the United States has been increasing steadily over the previous 10 years. In DC, these results are not mirrored. The suicide rate has a tendency to be lower than the rest of the country. During this retrospective review of suicides in DC, factors such as medical history and toxicology results were examined.In this study performed over 8 years (2009-2016), 394 suicides occurred. It was found that decedents committed suicide mostly by hanging (31.2%), firearms (20.3%), or drug intoxication (15.7%). The average age was 44.5 years. Similar to national statistics, male individuals committed suicide at a higher rate (77.9%) than did female individuals (22.1%). The toxicology data showed that ethanol (26.4%), antidepressants (20.1%), opioids (14.9%), and benzodiazepines (12.9%) were the drugs most frequently involved, although the finding of no drugs was most common (33.7%). Ethanol was present in 5 methods of suicide that include death by hanging, drowning, firearm, suffocation, and poisoning.This research provides information that may be useful for public health officials when confronting the issue of suicide. It is hoped that it will encourage other medical examiner offices to perform toxicological analysis and autopsy of all suicide cases.


Assuntos
Suicídio Consumado/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Asfixia/mortalidade , Depressores do Sistema Nervoso Central/análise , Criança , Grupos de Populações Continentais/estatística & dados numéricos , District of Columbia/epidemiologia , Afogamento/mortalidade , Etanol/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/mortalidade , Preparações Farmacêuticas/análise , Envenenamento/mortalidade , Estudos Retrospectivos , Distribuição por Sexo , Ferimentos por Arma de Fogo/mortalidade , Adulto Jovem
8.
Am J Physiol Gastrointest Liver Physiol ; 318(2): G265-G276, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31760766

RESUMO

Kras mutations are associated with pancreatic ductal adenocarcinoma (PDAC). Although tobacco smoking, pancreatitis, and obesity are known environmental risk factors for PDAC, the contribution of moderate alcohol intake to PDAC remains elusive. In the present study, we tested whether a combination of risk factors or moderate alcohol intake induces PDAC development in mice. Control Pdx1Cre and Pdx1Cre;LSL-KrasG12D mutant mice were fed a Western alcohol diet containing high levels of cholesterol and saturated fat, 3.5% alcohol, and lipopolysaccharide for 5 mo. In addition, mice were treated with cerulein, for induction of pancreatitis, and nicotine every month. Treatment with all of these risk factors promoted development of advanced pancreatic neoplasia and PDAC in the Pdx1Cre;LSL-KrasG12D mice but not in the control Pdx1Cre mice. Moderate alcohol intake or Western diet feeding also significantly promoted advanced neoplasia and PDAC development in Pdx1Cre;LSL-KrasG12D mice compared with mice fed a regular chow. Alcohol, but not Western diet, increased tumor development in the liver in the Pdx1Cre;LSL-KrasG12D mice, but its origin remained elusive due to leakiness of Pdx1Cre in hepatocytes. RNA-seq analysis revealed that alcohol feeding increases expression of markers for tumors (Epcam, Krt19, Prom1, Wt1, and Wwtr1), stroma (Dcn, Fn1, and Tnc), and cytokines (Tgfb1 and Tnf) and decreases expression of Fgf21 and Il6 in the pancreatic tumor tissues. Immunostaining showed heterogeneous expression of nephronectin, S100 calcium-binding protein A6, and vascular cell adhesion molecule 1 in pancreatic tumors surrounded by podoplanin-positive stromal cells. Our data indicate that moderate alcohol drinking is a risk factor for development of PDAC.NEW & NOTEWORTHY Heavy alcohol intake has been suspected to be a risk factor of pancreatic ductal adenocarcinoma (PDAC) in humans. However, the contribution of moderate alcohol intake to PDAC development remains elusive. In the present study, we experimentally show that moderate alcohol feeding significantly induces advanced stages of pancreatic intraepithelial neoplasia development and invasive PDAC in Pdx1Cre;LSL-KrasG12D mutant mice. Our data indicate that moderate alcohol drinking is a risk factor for PDAC.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Carcinógenos/toxicidade , Carcinoma Ductal Pancreático/induzido quimicamente , Depressores do Sistema Nervoso Central/toxicidade , Etanol/toxicidade , Neoplasias Pancreáticas/induzido quimicamente , Proteínas Proto-Oncogênicas p21(ras)/biossíntese , Proteínas Proto-Oncogênicas p21(ras)/genética , Animais , Carcinoma Ductal Pancreático/patologia , Ceruletídeo/farmacologia , Citocinas/metabolismo , Dieta Ocidental , Hepatócitos/metabolismo , Proteínas de Homeodomínio/biossíntese , Proteínas de Homeodomínio/genética , Neoplasias Hepáticas/induzido quimicamente , Camundongos , Mutação , Nicotina/farmacologia , Neoplasias Pancreáticas/patologia , Transativadores/biossíntese , Transativadores/genética
9.
Exp Clin Psychopharmacol ; 28(1): 112-129, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31219273

RESUMO

Although the strength of the effect produced by alcohol is generally dose dependent, its effect on behavior cannot be reliably predicted by the dose alone because the dose effect has been shown to vary. Acute behavioral tolerance is a rapid decrease in the dose effect of alcohol, seen to occur within the duration of a single dose. Numerous research paradigms have been used to examine acute behavioral tolerance, across an array of different behavioral measures. We have reviewed studies that used a research paradigm appropriate to test for acute behavioral tolerance. The primary aim was to examine the different paradigms that have been used to identify what empirical evidence of the effect has been found. The additional aims were to identify domains of behavior in which acute tolerance has been shown to occur and ascertain which conditions have been shown to influence it. Findings of acute tolerance were prevalent. Seven different research paradigms were identified, and each found evidence of acute behavioral tolerance in at least 1 study. The effect was not uniform across all behavioral measures. Subjective measures reliably showed the effect, but objective measures of behavior were less reliable, providing evidence that particular aspects of task performance are more sensitive to acute tolerance than others. The dose effect of alcohol for behavioral measures is often shown to decrease within the duration of a single dose. Investigations into, and considerations of, the effects of alcohol on behavior need to consider temporal changes in the dose effect. (PsycINFO Database Record (c) 2020 APA, all rights reserved).


Assuntos
Consumo de Bebidas Alcoólicas , Depressores do Sistema Nervoso Central , Tolerância a Medicamentos , Etanol , Relação Dose-Resposta a Droga , Humanos
10.
Toxicol Lett ; 319: 11-21, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31711802

RESUMO

Alcoholic liver injury (ALI) is a part of alcohol-related liver diseases. These diseases include steatohepatitis, alcoholic fibrosis, cirrhosis and hepatocellular carcinoma (HCC). Accumulating data indicates that alcohol metabolism and circulating endotoxin/lipopolysaccharide (LPS) contribute to macrophage activation, which leads to the development of ALI. Protein tyrosine phosphatase 1B (PTP1B) has been shown to be involved in many tissue inflammations as well as liver fibrosis; however, the role of PTP1B in ALI is still unclear. In this study, PTP1B expression was elevated in liver tissues and primary macrophages isolated from EtOH-fed mice. Moreover, PTP1B expression was elevated in RAW264.7 cells stimulated with alcohol and LPS. Additional studies showed that silencing of PTP1B reduced the inflammatory response and expression of inflammatory cytokines such as IL-1ß, IL-6 and TNF-α, while overexpression of PTP1B induced inflammation in RAW264.7 cells. In addition, we found that NF-κB pathway was activated in RAW264.7 cells stimulated with alcohol and LPS, and PTP1B silencing or overexpression could regulate NF-κB signaling. In conclusion, this study revealed the function of PTP1B in ALI via its regulation of the NF-κB signaling pathway and may provide theoretical support for further research on ALI.


Assuntos
Hepatopatias Alcoólicas/genética , Ativação de Macrófagos , NF-kappa B/genética , Proteína Tirosina Fosfatase não Receptora Tipo 1/genética , Transdução de Sinais/genética , Animais , Depressores do Sistema Nervoso Central/farmacologia , Citocinas/biossíntese , Etanol/farmacologia , Lipopolissacarídeos/farmacologia , Fígado/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Proteína Tirosina Fosfatase não Receptora Tipo 1/biossíntese , Células RAW 264.7 , Regulação para Cima
11.
Braz J Psychiatry ; 42(3): 295-308, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31859790

RESUMO

OBJECTIVE: Several studies have shown that the time of day regulates the reinforcing effects of cocaine. Additionally, melatonin and its MT1 and MT2 receptors have been found to participate in modulation of the reinforcing effects of such addictive drugs as cocaine. Loss of the diurnal variation in cocaine-induced locomotor sensitization and cocaine-induced place preference has been identified in pinealectomized mice. In addition, several studies in rodents have shown that administration of melatonin decreased the reinforcing effects of cocaine. The objective of this study was to evaluate the effect of melatonin on cocaine-induced locomotor activity in pinealectomized rats at different times of day (zeitgeber time [ZT]4, ZT10, ZT16, and ZT22). METHODS: Naïve, pinealectomized Wistar rats received cocaine at different times of day. Melatonin was administered 30 min before cocaine; luzindole was administered 15 min prior to melatonin and 45 min before cocaine. After administration of each treatment, locomotor activity for each animal was recorded for a total of 30 min. Pinealectomy was confirmed at the end of the experiment through melatonin quantitation by ELISA. RESULTS: Cocaine-induced locomotor activity varied according to the time of day. Continuous lighting and pinealectomy increased cocaine-induced locomotor activity. Melatonin administration decreased cocaine-induced locomotor activity in naïve and pinealectomized rats at different times of day. Luzindole blocked the melatonin-induced reduction in cocaine-induced locomotor activity in pinealectomized rats. CONCLUSION: Given its ability to mitigate various reinforcing effects of cocaine, melatonin could be a useful therapy for cocaine abuse.


Assuntos
Depressores do Sistema Nervoso Central/farmacologia , Transtornos Relacionados ao Uso de Cocaína/tratamento farmacológico , Locomoção/efeitos dos fármacos , Melatonina/farmacologia , Pinealectomia , Animais , Ritmo Circadiano , Ensaio de Imunoadsorção Enzimática , Humanos , Masculino , Distribuição Aleatória , Ratos Wistar , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento , Triptaminas/farmacologia
12.
Oxid Med Cell Longev ; 2019: 1974982, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31885774

RESUMO

The exogenous lipoic acid (LA) is successfully used as a drug in the treatment of many diseases. It is assumed that after administration, LA is transported to the intracellular compartments and reduced to dihydrolipoic acid (DHLA) which is catalyzed by NAD(P)H-dependent enzymes. The purpose of this study was to investigate whether LA can attenuate cardiovascular disturbances induced by ethanol (EtOH) and disulfiram (DSF) administration separately or jointly in rats. For this purpose, we measured systolic and diastolic blood pressure, recorded electrocardiogram (ECG), and estimated mortality of rats. We also studied the activity of aldehyde dehydrogenase (ALDH) in the rat liver. It was shown for the first time that LA partially attenuated the cardiac arrhythmia (extrasystoles and atrioventricular blocks) induced by EtOH and reduced the EtOH-induced mortality of animals, which suggests that LA may have a potential for use in cardiac disturbance in conditions of acute EtOH intoxication. The administration of EtOH, LA, and DSF separately or jointly affected the ALDH activity in the rat liver since a significant decrease in the activity of the enzyme was observed in all treatment groups. The results indicating that LA is an inhibitor of ALDH activity are very surprising.


Assuntos
Inibidores de Acetaldeído Desidrogenases/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Sistema Cardiovascular/efeitos dos fármacos , Depressores do Sistema Nervoso Central/efeitos adversos , Dissulfiram/efeitos adversos , Etanol/efeitos adversos , Ácido Tióctico/uso terapêutico , Animais , Masculino , Ratos , Ratos Wistar , Ácido Tióctico/farmacologia
13.
Neurology ; 93(21): e1944-e1954, 2019 11 19.
Artigo em Inglês | MEDLINE | ID: mdl-31653706

RESUMO

OBJECTIVE: To determine the association between alcohol abuse (AA) and alcohol withdrawal (AW) with acute ischemic stroke (AIS) outcomes. METHODS: All adult AIS admissions in the United States from 2004 to 2014 were identified from the National Inpatient Sample (weighted n = 4,438,968). Multivariable-adjusted models were used to evaluate the association of AW with in-hospital medical complications, mortality, cost, and length of stay in patients with AIS. RESULTS: Of the AA admissions, 10.6% of patients, representing 0.4% of all AIS, developed AW. The prevalence of AA and AW in AIS increased by 45.2% and 40.0%, respectively, over time (p for trend <0.001). Patients with AA were predominantly men (80.2%), white (65.9%), and in the 40- to 59-year (44.6%) and 60- to 79-year (45.6%) age groups. After multivariable adjustment, AIS admissions with AW had >50% increased odds of urinary tract infection, pneumonia, sepsis, gastrointestinal bleeding, deep venous thrombosis, and acute renal failure compared to those without AW. Patients with AW were also 32% more likely to die during their AIS hospitalization compared to those without AW (odds ratio 1.32, 95% confidence interval 1.11-1.58). AW was associated with ≈15-day increase in length of stay and ≈$5,000 increase in hospitalization cost (p < 0.001). CONCLUSION: AW is associated with increased cost, longer hospitalizations, and higher odds of medical complications and in-hospital mortality after AIS. Proactive surveillance and management of AW may be important in improving outcomes in these patients.


Assuntos
Alcoolismo/epidemiologia , Isquemia Encefálica/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Síndrome de Abstinência a Substâncias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Alcoolismo/economia , Alcoolismo/fisiopatologia , Isquemia Encefálica/economia , Isquemia Encefálica/fisiopatologia , Isquemia Encefálica/terapia , Depressores do Sistema Nervoso Central/efeitos adversos , Etanol/efeitos adversos , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prognóstico , Respiração Artificial/estatística & dados numéricos , Acidente Vascular Cerebral/economia , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Síndrome de Abstinência a Substâncias/economia , Síndrome de Abstinência a Substâncias/fisiopatologia , Síndrome de Abstinência a Substâncias/terapia , Terapia Trombolítica , Estados Unidos/epidemiologia , Adulto Jovem
14.
Life Sci ; 238: 116898, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31610193

RESUMO

AIMS: Learning and memory impairment is a common symptom in the early stages of various types of dementia. It is likely to reduce the incidence of dementia with correct intervention. α-Asarone is the main bioactive substance isolated from Acorus tatarinowii Schott and has been proven to improve memory dysfunction; however, at present, the specific underlying mechanism is poorly understood. The aim of the present study was to investigate the effect of α-asarone on ethanol-impaired cognitive ability and explore the underlying mechanism in mice. MAIN METHODS: A mouse model of impaired learning and memory was created by ethanol (2.0 g/kg, i.g.). α-Asarone (7.5, 15 or 30 mg/kg, i.p.) was delivered 10 min prior to ethanol administration. The behavioral effect of α-asarone was evaluated using the novel object recognition test. Glutamate (Glu) and γ-aminobutyric acid (GABA) levels in the hippocampus were determined by ELISA, and the protein expression levels of hippocampal GluR2, NMDAR2B, SYNΙ, GLT-1 and CaMKⅡ were detected by western blotting. KEY FINDINGS: Pretreatment with α-asarone significantly improved the behavioral performance, regulated the imbalance of Glu and GABA in the hippocampus and the abnormal expression of related proteins. A possible underlying mechanism is regulation of the calcium signaling cascade to correct functioning of related proteins, and thus, maintain the level of Glu. SIGNIFICANCE: Our results show that the improvement in learning and memory elicited by α-asarone may providing a possible novel candidate for the prevention of learning and memory impairment in the early stages of dementia.


Assuntos
Anisóis/farmacologia , Depressores do Sistema Nervoso Central/toxicidade , Etanol/toxicidade , Fibrinolíticos/farmacologia , Hipocampo/efeitos dos fármacos , Aprendizagem/efeitos dos fármacos , Transtornos da Memória/tratamento farmacológico , Animais , Modelos Animais de Doenças , Ácido Glutâmico/metabolismo , Hipocampo/metabolismo , Masculino , Transtornos da Memória/induzido quimicamente , Transtornos da Memória/metabolismo , Transtornos da Memória/patologia , Camundongos , Camundongos Endogâmicos C57BL , Neurotransmissores/metabolismo
15.
Forensic Sci Int ; 304: 109962, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31610334

RESUMO

Melatonin (MEL) is a neurohormone in humans produced in a number of locations. Starting with the amino acid tryptophan, MEL is produced through a number of enzymatic steps that includes serotonin as an intermediate compound. The primary production of MEL is in the pineal gland located in the brain. It is directly associated with the the suprachiasmatic nucleus (SCN) located in the hypothalamus. In young and adult humans, the blood levels of MEL are typically in the picogram levels and produced in a cyclic schedule highly regulated by light detected in the retina by intrinsically photosensitive retinal ganglion cells (ipRGCs), resulting in production primarily during periods of darkness. During periods of light, MEL levels are typically very low or undetectable. Basal levels of MEL in infants have been observed to be either undetectable or also in the picogram levels, although some medical treatment has involved administration of exogenous MEL resulting in peak levels in the nanogram range. MEL is considered to be well tolerated and there have been limited reports of toxicity. In this case, an infant was found unresponsive and cause of death was ruled as Undetermined. Melatonin was detected in the peripheral blood at a concentration of 1,400ng/mL.


Assuntos
Depressores do Sistema Nervoso Central/envenenamento , Morte Súbita/etiologia , Melatonina/envenenamento , Depressores do Sistema Nervoso Central/administração & dosagem , Depressores do Sistema Nervoso Central/sangue , Cromatografia Líquida , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Lactente , Melatonina/administração & dosagem , Melatonina/sangue , Espectrometria de Massas em Tandem , Gêmeos
16.
Prog Mol Biol Transl Sci ; 167: 179-221, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31601404

RESUMO

Alcohol use disorder (AUD) is a chronic relapsing disorder with wide-ranging health consequences. Alcohol targets the central nervous system producing neurodegeneration and subsequent cognitive and behavioral deficits, but the mechanisms behind these effects remain unclear. Recently, evidence has been mounting for the role of neuroimmune activation in the pathogenesis of AUDs, but our nascent state of knowledge about the interaction of alcohol with the neuroimmune system supports that the relationship is complicated. As the resident macrophage of the central nervous system, microglia are a central focus. Human and animal research on the interplay between microglia and alcohol in AUDs has proven to be complex, and though early research focused on a pro-inflammatory phenotype of microglia, the anti-inflammatory and homeostatic roles of microglia must be considered. How these new roles for microglia should be incorporated into our thinking about the neuroimmune system in AUDs is discussed in the context of developing novel pharmacotherapies for AUDs.


Assuntos
Alcoolismo/patologia , Anti-Inflamatórios/uso terapêutico , Etanol/toxicidade , Microglia/patologia , Alcoolismo/tratamento farmacológico , Alcoolismo/etiologia , Animais , Depressores do Sistema Nervoso Central/toxicidade , Humanos , Microglia/efeitos dos fármacos
17.
J Forensic Leg Med ; 68: 101868, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31585334

RESUMO

The aim of this study was to analyze the prevalence of ethanol in individuals (277) subjected to a mandatory medico-legal autopsy in the Institute of Legal Medicine of Las Palmas (Canary Islands, Spain) during 2016-2017, comparing the results with data published in 2015. Blood and/or vitreous humor samples were analyzed by gas chromatography. 31.8% of the individuals were positive to ethanol. We observed a decrease in the prevalence of ethanol among males (p = 0.002). While the prevalence of ethanol was reduced, the concentration among those positive subjects has increased. 11.9% of the series died in a traffic accident and the percentage of positive to ethanol decreased in relation to 2015 (64.3, 25.0, and 35.3%). The number of suicides remains constant, although the age of the suiciders has been significantly reduced (p = 0.022). The results of this study indicate that ethanol is still heavily involved in non-natural deaths.


Assuntos
Acidentes de Trânsito/mortalidade , Depressores do Sistema Nervoso Central/análise , Etanol/análise , Suicídio Consumado/estatística & dados numéricos , Violência/estatística & dados numéricos , Corpo Vítreo/química , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Distribuição por Sexo , Espanha/epidemiologia , Adulto Jovem
19.
Ital J Pediatr ; 45(1): 122, 2019 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-31547831

RESUMO

INTRODUCTION: Melatonin has been studied and used for several years as a sleep-wake cycle modulator in patients with sleep disorders. Experimental evidence has demonstrated the multiple neuroprotective benefits of this indoleamine secreted by the pineal gland. Melatonin is also used in neurological investigations, for its ability to induce sleep in children. In fact, it favors falling asleep during electroencephalogram, Magnetic Resonance Imaging (MRI), and during brainstem auditory evoked potentials. Previous studies are focused on infants and children. No investigation have been performed in neonates, before or during instrumental assessments. MATERIAL AND METHODS: One hundred ten newborns (term and preterm) undergoing brain MRI were enrolled in the study. Thirty minutes before the planned time for the examination, we administered a single dose solution of melatonin- tryptophan-vitamin B6. Twenty minutes after the initial administration of 2 mg, a second dose of 1 mg was administered, if the baby was still awake. If after further 15 min the baby was still not sleeping, an additional dose of 1 mg was administered. RESULTS: In 106 patients we obtained adequate sedation without adverse events, allowing us to perform an adequate quality MRI, with a median time of 25 min to reach sleeping. Only in three patients MRI could not be performed. In patients having a large weight, higher doses of melatonin were necessary to reach sleeping. Considering the pro kg dose of melatonin, the average dose that induced sleepiness in neonates was 0,64 ± 0.16 mg/Kg. CONCLUSION: A solution based on Melatonin- tryptophan-vitamin B6 can be a helpful sedative to administer to neonates undergoing brain MRI, avoiding the use of anesthetics and achieving adequate assessments.


Assuntos
Encéfalo/diagnóstico por imagem , Depressores do Sistema Nervoso Central/administração & dosagem , Imagem por Ressonância Magnética , Melatonina/administração & dosagem , Triptofano/administração & dosagem , Vitamina B 6/administração & dosagem , Antidepressivos de Segunda Geração/administração & dosagem , Sedação Consciente , Feminino , Humanos , Hipnóticos e Sedativos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Complexo Vitamínico B/administração & dosagem
20.
Psychol Addict Behav ; 33(7): 581-594, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31545622

RESUMO

Decades of research have tested the hypothesis that alcohol consumption buffers against the effects of stress. Despite this large body of literature, the evidence from carefully controlled laboratory studies in which alcohol is administered and negative affect is measured in response to a stressor is mixed. The goal of the current meta-analysis was to quantitatively summarize laboratory studies of alcohol's stress response dampening effects and test theoretical and methodological factors that explain variation in effect sizes across studies. A literature search identified 52 studies that administered alcohol and measured negative affect, as defined by self-report and/or psychophysiological response to a stressor. The results showed post-stressor negative affect was significantly lower in the alcohol condition compared to the control conditions (placebo and control), d = -.38, 95% CI [-.56, -.21], k = 130, m = 50. For changes in pre-to-post stressor affect, there was evidence of a small, but not significant, difference between the conditions such that negative affect increased slightly less in the alcohol condition, d = .49, 95% CI [.22, .77], k = 54, m = 27, compared to the control conditions, d = .60, 95% CI [.39, .80], k = 65, m = 26. Moderator analyses did not yield significant results but highlighted some areas for further research. Rather than providing definitive results on the topic of stress response dampening, this meta-analysis indicates several opportunities for refinement of method and theory to continue to improve the science in this area of research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Afeto/efeitos dos fármacos , Consumo de Bebidas Alcoólicas , Depressores do Sistema Nervoso Central/farmacologia , Etanol/farmacologia , Estresse Psicológico , Humanos
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