RESUMO
La distonía aguda inducida por antipsicóticos sigue siendo una patología frecuente en los servicios de emergencia psiquiátrica. Sin embargo, la luxación de la articulación tómporo-mandibular, como secuela de distonía oromandibular, es una presentación inusual dentro de esta casuística. Presentamos el caso de una paciente mujer de 20 años de edad, quien recibió haloperidol intramuscular tras sendas crisis de agitación psicomotriz y persistencia de riesgo suicida, y que luego desarrolló distonía oro-mandibular, a consecuencia de la cual sufrió luxación témporomandibular unilateral. Como conclusión, se recomienda no repetir la administración de antipsicóticos parenterales de alta potencia a personas que han padecido luxación de la articulación témporo-mandibular como consecuencia de distonía secundaria a estos fármacos. Se plantea además la posibilidad de que, debido al uso masivo y creciente de antipsicóticos atípicos en el momento actual, la capacitación de los psiquiatras en cuanto a predicción y manejo de efectos adversos de los neurolépticos puede estar siendo negligida.
Antipsychotic-induced acute dystonia remains as a common presentation in psychiatric emergency services. However, luxation of the temporo-mandibular joint, as a sequel to oro-mandibular dystonia is an unusual clinical occurrence. We report the case of a 20-years-old-woman who received intramuscular haloperidol after two crisis of psychomotor agitation with persistent suicidal risk, developed then oro-mandibular dystonia and, as a result of which, suffered unilateral temporo-mandibular dislocation. A recommendation is made not to repeat a parenteral administration of high-potency antipsychotics to patients who have suffered dislocation of the temporo-mandibular joint as a result of secondary dystonia to these drugs. Additionally, we examine the possibility that, due to the massive and growing use of atypical antipsychotics at the present time, the training of psychiatrists about prediction and management of adverse effects of neuroleptics may be neglected.
Assuntos
Feminino , Humanos , Adulto Jovem , Antipsicóticos/administração & dosagem , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Distonia , Haloperidol/uso terapêutico , Luxações ArticularesRESUMO
Currently, there is no standardized approach to the management of complex febrile seizures in children and there are no published practice guidelines for the procurement of neuroimaging. Presented is a 2-year-old female patient who experienced a 3- to 5-minute episode of staring and unilateral mouth twitching associated with high fever. On initial presentation, the patient appeared well and had a normal neurological examination. No focus of infection was identified, and she was diagnosed with complex febrile seizure. The patient was discharged home with close neurology and primary care follow-up but returned the following day with altered mental status, toxic appearance, and right lower extremity weakness. Magnetic resonance imaging of the brain revealed left-sided cranial empyema and the patient was managed with antibiotics and surgical drainage. A literature review to answer the question "Do children with complex febrile seizures require emergent neuroimaging?" yielded a small number of retrospective reviews describing the utility of computed tomography, magnetic resonance imaging and lumbar puncture in the work-up of febrile seizures. Current evidence indicates that neuroimaging is not indicated in an otherwise healthy child who presents with complex febrile seizure if the patient is well appearing and has no evidence of focal neurological deficit on examination. As this case demonstrates, however, serious conditions such as meningitis and brain abscess (though rare) should be considered in the differential diagnosis of complex febrile seizure and physicians should remain aware that the need for neuroimaging and/or lumbar puncture may arise in the appropriate clinical setting.
Assuntos
Abscesso Encefálico/diagnóstico , Encéfalo/patologia , Convulsões Febris/diagnóstico , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Neuroimagem , Tomografia Computadorizada por Raios XRESUMO
El proyecto de modificación del Código Penal que propone el Gobierno introduce elementos que pueden ser seriamente lesivos para los derechos y libertades de las personas que padecen algún trastorno mental. El presente documento hace un análisis de dicho proyecto en lo que se refiere especialmente a las medidas de seguridad, propone una serie de enmiendas y fija la posición de la AEN en este tema (AU)
The project of modification of the Penal Code that the Government proposes introduces elements that can be seriously harmful for the rights and freedoms of the persons who suffer some mental disorder. The present document does an analysis of the above mentioned project in what it refers specially to the safety measures, proposes a series of amendments and fixes the position of the AEN in this topic (AU)
Assuntos
Humanos , Pessoas Mentalmente Doentes/legislação & jurisprudência , Serviços de Saúde Mental/legislação & jurisprudência , /legislação & jurisprudência , Responsabilidade Penal , Segurança do Paciente , Direitos do Paciente , Comportamento Perigoso , Crime/legislação & jurisprudênciaRESUMO
OBJECTIVE: To assess the frequency of functional gastrointestinal disorders and gastroesophageal reflux disease in adults with uninvestigated dyspepsia in a general teaching hospital in Lima, Peru. MATERIAL AND METHODS: Cross-sectional descriptive study performed at Hospital Nacional Cayetano Heredia Lima, Peru. Data was collected from questionnaires for Functional Gastrointestinal Disorders (FGID) based on Rome III criteria and from surveys for diagnosis of GERD applied to eligible patients who visited the gastroenterology unit from July to December 2011. Also, we collected the endoscopy's reports. RESULTS: Among 110 patients who participated in the study, 70.9% were female and the mean age was 49.4 years (range 20-77, SD: ± 13.1). FGID was found in 82 subjects (74.6%) based on Rome III criteria. The most common FGID was functional dyspepsia (71.8%), followed by belching disorder (57.3%), nausea and vomiting disorder (27.3%) and irritable bowel syndrome (18.2%). Ninety-one patients (82.7%) were diagnosed of GERD, being the most common symptom regurgitation (80.0%). Structural abnormalities were found by upper endoscopy in 25 patients (22.7%). CONCLUSIONS: We found a high frequency of GERD, belching disorder, nausea and vomiting disorder and irritable bowel syndrome among adult patients with uninvestigated dyspepsia. In addition, we found a high frequency of overlapping disorders in the same patient. Our results suggest the necessity to recognize the different types of FGID in order to avoid the under diagnosis of common conditions in the outpatient setting.
Assuntos
Dispepsia/complicações , Gastroenteropatias/complicações , Gastroenteropatias/epidemiologia , Adulto , Idoso , Estudos Transversais , Feminino , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/epidemiologia , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Adulto JovemRESUMO
Objetivo: Evaluar la frecuencia de trastornos digestivos funcionales y enfermedad por reflujo gastroesofágico en pacientes adultos con dispepsia no investigada en un hospital docente localizado en Lima, Perú. Material y métodos: Estudio descriptivo realizado en el Hospital Nacional Cayetano Heredia, Lima, Perú. Se recolectaron los resultados de las endoscopías y de los cuestionarios para Trastorno Digestivo Funcional (TDF) y Enfermedad por Reflujo Gastro Esofágico (ERGE) aplicados a pacientes con criterios de selección que acudieron al servicio de gastroenterología desde julio hasta diciembre del 2011. Resultados: 110 pacientes participaron en el estudio, 70,9% fueron mujeres y la edad promedio fue 49,4 años (rango 20-77, DE: ±13,1). 82 pacientes (76,4%) presentaron algún TDF. El más común fue dispepsia funcional (71,8%), seguido por el trastorno por eructos (57,3%), trastorno por náuseas y vómitos (27,3%) y síndrome de intestino irritable (18,2%). 91 pacientes (82,7%) presentaron ERGE, siendo el síntoma más común la regurgitación (80,0%). Las endoscopias mostraron que 25 pacientes (22,7%) tenían alguna lesión estructural. Conclusiones: Se encontró una alta frecuencia de ERGE, trastorno por eructos, trastorno por nauseas y vómitos y síndrome de intestino irritable entre los pacientes con dispepsia no investigada. Además, se encontró una alta frecuencia de superposición de trastornos en un mismo paciente. Nuestros resultados sugieren la necesidad de reconocer los diferentes tipos de TDF para evitar el sub-diagnóstico de éstos desórdenes.
Objective: To assess the frequency of functional gastrointestinal disorders and gastroesophageal reflux disease in adults with uninvestigated dyspepsia in a general teaching hospital in Lima, Peru. Material and methods: Cross-sectional descriptive study performed at Hospital Nacional Cayetano Heredia Lima, Peru. Data was collected from questionnaires for Functional Gastrointestinal Disorders (FGID) based on Rome III criteria and from surveys for diagnosis of GERD applied to eligible patients who visited the gastroenterology unit from July to December 2011. Also, we collected the endoscopys reports. Results: Among 110 patients who participated in the study, 70.9% were female and the mean age was 49.4 years (range 2077, SD: ± 13.1). FGID was found in 82 subjects (74.6%) based on Rome III criteria. The most common FGID was functional dyspepsia (71.8%), followed by belching disorder (57.3%), nausea and vomiting disorder (27.3%) and irritable bowel syndrome (18.2%). Ninety-one patients (82.7%) were diagnosed of GERD, being the most common symptom regurgitation (80.0%). Structural abnormalities were found by upper endoscopy in 25 patients (22.7%). Conclusions: We found a high frequency of GERD, belching disorder, nausea and vomiting disorder and irritable bowel syndrome among adult patients with uninvestigated dyspepsia. In addition, we found a high frequency of overlapping disorders in the same patient. Our results suggest the necessity to recognize the different types of FGID in order to avoid the under diagnosis of common conditions in the outpatient setting.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Dispepsia/complicações , Gastroenteropatias/complicações , Gastroenteropatias/epidemiologia , Estudos Transversais , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/epidemiologia , Hospitais , PeruRESUMO
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