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1.
Braz. j. biol ; 82: e236499, 2022. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1153462

RESUMO

Abstract Distribution pattern and relative abundance of the agricultural rodent pests of rain-fed and irrigated areas of district Swat Khyber Pakhtunkhwa, Pakistan were recorded from April 2011 to November 2013 using wire mesh live traps. A total of 350 rodents (269 Rattus rattus and 81 Mus musculus) were captured under 2268 trap nights (trap success: 0.15). Regression of daily captures on cumulative captures revealed an estimate of 350 rodents from all the sampled structures with an average of 21.8 rodents per crop field. House rats (R. rattus; 76.8% of captures) were numerically dominant in almost all types of agricultural fields, and were significantly different from the mice (Mus musculus; 23.1% of captures). Both species were found together in some fields. The sex ratio revealed that males outnumbered the females in both of the reported species.


Resumo O padrão de distribuição e a abundância relativa de pragas de roedores agrícolas nas áreas irrigadas e irrigadas do distrito Swat Khyber Pakhtunkhwa, Paquistão foram registrados de abril de 2011 a novembro de 2013 usando armadilhas vivas de malha de arame. Um total de 350 roedores (269 Rattus rattus e 81 Mus musculus) foram capturados em 2268 noites de armadilha (sucesso da armadilha: 0,15). A regressão das capturas diárias em capturas cumulativas revelou uma estimativa de 350 roedores de todas as estruturas amostradas, com uma média de 21,8 roedores por campo agrícola. Os ratos domésticos (R. rattus; 76,8% das capturas) foram numericamente dominantes em quase todos os tipos de campos agrícolas e foram significativamente diferentes dos camundongos (Mus musculus; 23,1% das capturas). Ambas as espécies foram encontradas juntas em alguns campos. A proporção de sexo revelou que os machos superaram as fêmeas em ambas as espécies relatadas.

2.
Braz. j. biol ; 82: e238665, 2022. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1153463

RESUMO

Abstract Malakand region is an endemic area for cutaneous leishmaniasis (CL). However, there are limited number of studies of this disease in Pakistan. Therefore, a study was conducted to understand the level of awareness attitude and practice among the residents of Makaland towards CL and the disease vectors. This study adopted a cross-sectional approach with a total of 400 respondents (n=93 rural and n= 307 urban). Overall, the population in Malakand region (61.2%) were well-informed in the role of sand fly in transmitting diseases, but most lack knowledge on the vector's behavior and almost a quarter (24.5%) were unable to provide knowledge on proper control measures. Alarmingly, the practice and attitudes of the general population was not satisfactory as close to half (49.8%) of the population did adopt any control method. This study calls for increase in awareness through health education campaign to reduce the risk of cutaneous leishmaniasis outbreaks in the future.


Resumo A região de Malakand é uma área endêmica para leishmaniose cutânea (CL). No entanto, há um número limitado de estudos sobre esta doença no Paquistão. Portanto, foi realizado um estudo para entender o nível de atitude e prática de conscientização entre os residentes de Makaland em relação aos CL e os vetores da doença. Este estudo adotou uma abordagem transversal com um total de 400 entrevistados (n = 93 rural e n = 307 urbano). No geral, a população da região de Malakand (61,2%) estava bem informada sobre o papel da mosca na transmissão de doenças, mas a maioria não possui conhecimento sobre o comportamento do vetor e quase um quarto (24,5%) foi incapaz de fornecer conhecimento sobre medidas de controle adequadas . De maneira alarmante, a prática e as atitudes da população em geral não foram satisfatórias, pois cerca da metade (49,8%) da população adotou algum método de controle. Este estudo apela ao aumento da conscientização por meio de campanhas de educação em saúde para reduzir o risco de surtos de leishmaniose cutânea no futuro.

3.
Appl Clin Inform ; 12(2): 355-361, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33910260

RESUMO

BACKGROUND: Drug alerts are clinical decision support tools intended to prevent medication misadministration. In teaching hospitals, residents encounter the majority of the drug alerts while learning under variable workloads and responsibilities that may have an impact on drug-alert response rates. OBJECTIVES: This study was aimed to explore drug-alert experience and salience among postgraduate year 1 (PGY-1), postgraduate year 2 (PGY-2), and postgraduate year 3 (PGY-3) internal medicine resident physicians at two different institutions. METHODS: Drug-alert information was queried from the electronic health record (EHR) for 47 internal medicine residents at the University of Pennsylvania Medical Center (UPMC) Pinnacle in Pennsylvania, and 79 internal medicine residents at the MetroHealth System (MHS) in Ohio from December 2018 through February 2019. Salience was defined as the percentage of drug alerts resulting in removal or modification of the triggering order. Comparisons were made across institutions, residency training year, and alert burden. RESULTS: A total of 126 residents were exposed to 52,624 alerts over a 3-month period. UPMC Pinnacle had 15,574 alerts with 47 residents and MHS had 37,050 alerts with 79 residents. At MHS, salience was 8.6% which was lower than UPMC Pinnacle with 15%. The relatively lower salience (42% lower) at MHS corresponded to a greater number of alerts-per-resident (41% higher) compared with UPMC Pinnacle. Overall, salience was 11.6% for PGY-1, 10.5% for PGY-2, and 8.9% for PGY-3 residents. CONCLUSION: Our results are suggestive of long-term drug-alert desensitization during progressive residency training. A higher number of alerts-per-resident correlating with a lower salience suggests alert fatigue; however, other factors should also be considered including differences in workload and culture.

4.
Braz J Biol ; 82: e238665, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33825759

RESUMO

Malakand region is an endemic area for cutaneous leishmaniasis (CL). However, there are limited number of studies of this disease in Pakistan. Therefore, a study was conducted to understand the level of awareness attitude and practice among the residents of Makaland towards CL and the disease vectors. This study adopted a cross-sectional approach with a total of 400 respondents (n=93 rural and n= 307 urban). Overall, the population in Malakand region (61.2%) were well-informed in the role of sand fly in transmitting diseases, but most lack knowledge on the vector's behavior and almost a quarter (24.5%) were unable to provide knowledge on proper control measures. Alarmingly, the practice and attitudes of the general population was not satisfactory as close to half (49.8%) of the population did adopt any control method. This study calls for increase in awareness through health education campaign to reduce the risk of cutaneous leishmaniasis outbreaks in the future.


Assuntos
Leishmaniose Cutânea , Psychodidae , Animais , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Leishmaniose Cutânea/epidemiologia , Paquistão/epidemiologia , População Rural , População Urbana
5.
Braz J Biol ; 82: e236499, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33729383

RESUMO

Distribution pattern and relative abundance of the agricultural rodent pests of rain-fed and irrigated areas of district Swat Khyber Pakhtunkhwa, Pakistan were recorded from April 2011 to November 2013 using wire mesh live traps. A total of 350 rodents (269 Rattus rattus and 81 Mus musculus) were captured under 2268 trap nights (trap success: 0.15). Regression of daily captures on cumulative captures revealed an estimate of 350 rodents from all the sampled structures with an average of 21.8 rodents per crop field. House rats (R. rattus; 76.8% of captures) were numerically dominant in almost all types of agricultural fields, and were significantly different from the mice (Mus musculus; 23.1% of captures). Both species were found together in some fields. The sex ratio revealed that males outnumbered the females in both of the reported species.


Assuntos
Chuva , Roedores , Agricultura , Animais , Feminino , Masculino , Camundongos , Paquistão , Ratos , Simbiose
6.
Braz J Biol ; 82: e238665, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33787717

RESUMO

Malakand region is an endemic area for cutaneous leishmaniasis (CL). However, there are limited number of studies of this disease in Pakistan. Therefore, a study was conducted to understand the level of awareness attitude and practice among the residents of Makaland towards CL and the disease vectors. This study adopted a cross-sectional approach with a total of 400 respondents (n=93 rural and n= 307 urban). Overall, the population in Malakand region (61.2%) were well-informed in the role of sand fly in transmitting diseases, but most lack knowledge on the vector's behavior and almost a quarter (24.5%) were unable to provide knowledge on proper control measures. Alarmingly, the practice and attitudes of the general population was not satisfactory as close to half (49.8%) of the population did adopt any control method. This study calls for increase in awareness through health education campaign to reduce the risk of cutaneous leishmaniasis outbreaks in the future.


Assuntos
Leishmaniose Cutânea , Psychodidae , Animais , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Leishmaniose Cutânea/epidemiologia , Paquistão/epidemiologia , População Rural , População Urbana
7.
Spectrochim Acta A Mol Biomol Spectrosc ; 252: 119495, 2021 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-33524820

RESUMO

In the present study, different spectroscopic techniques have been used to study the binding interaction between the antidepressant drug fluvoxamine and human serum albumin under simulated physiological conditions (pH 7.4). The utilized spectroscopic techniques include fluorescence emission spectroscopy, synchronous fluorescence spectroscopy, UV-Vis absorption spectroscopy, Fourier Transform Infrared spectroscopy (FT-IR), and molecular modeling methods. The obtained results revealed that the formation of a complex between human serum albumin and fluvoxamine was responsible for quenching the native fluorescence of human serum albumin. The results indicated that the quenching mechanism between human serum albumin and fluvoxamine was static. Besides, the binding constant (K), number of binding sites (n), thermodynamic parameters (ΔH, ΔS, and ΔG), and binding forces were calculated at three different temperatures (298, 310, and 318 K). These data proposed that hydrophobic forces were the principal intermolecular forces stabilizing the complex. From the molecular docking results, it could be deduced that fluvoxamine was inserted into sub-domain II A (site I) of human serum albumin and led to a slight change in human serum albumin conformation.


Assuntos
Fluvoxamina , Simulação de Acoplamento Molecular , Albumina Sérica Humana , Sítios de Ligação , Dicroísmo Circular , Humanos , Ligação Proteica , Soroalbumina Bovina/metabolismo , Espectrometria de Fluorescência , Espectroscopia de Infravermelho com Transformada de Fourier , Termodinâmica
8.
Braz. j. biol ; 81(1): 18-26, Feb. 2021. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1153311

RESUMO

Abstract Plant growth regulators and improved planting density are the innovative techniques in the establishment of more productive cotton crop. A field study was planned to assess the role of growth regulators in the resource utilization efficiency of cotton cultivars under different row spacing at Agronomic Research Area, Bahauddin Zakariya University Multan and Usmania Agricultural Farm, Shujaabad during Kharif 2012. The study was comprised of cotton cultivars viz. CIM-573 and CIM-598, cultivated under conventional (75 cm), medium (50 cm) and improved ultra-narrow row spacing (25 cm) and foliar spray of growth regulators viz. moringa leaf extract (MLE) and mepiquat chloride (MC), either alone or in combination, distilled water as a control. The application of MLE alone and in combination (MLE + MC) showed the promoting effect on crop growth rate, net assimilation rate, leaf area index, leaf area duration, sympodial branches and number of bolls leading to higher seed cotton yield of both cotton cultivars grown under conventional row spacing. While application of MC averts the plant growth without considerably improving the productivity. MLE being rich source of growth promoting hormone and nutrients showed its potential to a far greater extent under conventional row spacing in efficient utilization of available resources compared to MC and distilled water.


Resumo Reguladores de crescimento de plantas e melhor densidade de plantio são técnicas inovadoras no estabelecimento de culturas mais produtivas de algodão. Um estudo de campo foi planejado com o objetivo de avaliar o papel dos reguladores de crescimento na eficiência de uso de recursos de cultivares de algodão sob diferentes espaçamentos na Área de Pesquisa Agronômica, da Universidade Multil de Bahauddin Zakariya, e na Fazenda Agrícola da Usmania, Shujabad, durante o Kharif 2012. O estudo foi composto de cultivares de algodão CIM-573 e CIM-598, cultivados em espaçamento de linhas convencional (75 cm), médio (50 cm) e superestreito (25 cm) e de pulverização foliar de reguladores de crescimento, a saber, extrato de folhas de moringa (MLE) e cloreto de mepiquat (MC), isoladamente ou em combinação, e água destilada como controle. A aplicação de MLE isoladamente e em combinação (MLE + MC) mostrou efeito promotor na taxa de crescimento da cultura, taxa de assimilação líquida, índice de área foliar, duração de área foliar, ramos simpodiais e número de cápsulas levando à maior produção de algodão nas cultivares com espaçamento de linha convencional. Em contrapartida, a aplicação de MC evitou o crescimento da planta sem melhorar consideravelmente a produtividade. O MLE, por ser uma rica fonte de hormônio promotor de crescimento e nutrientes, mostrou seu potencial em uma extensão muito maior sob o espaçamento convencional entre as linhas no uso eficiente dos recursos disponíveis em comparação com o MC e a água destilada.

9.
Pain ; 2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33470748

RESUMO

ABSTRACT: Spinal cord stimulation (SCS) is an interventional non-pharmacologic treatment used for chronic pain and other indications. Methods for evaluating the safety and efficacy of SCS have evolved from uncontrolled and retrospective studies to prospective randomized controlled trials (RCTs). While randomization overcomes certain types of bias, additional challenges to the validity of RCTs of SCS include blinding, choice of control groups, non-specific effects of treatment variables (e.g., paresthesia, device programming and recharging, psychological support, and rehabilitative techniques), and safety considerations. In order to address these challenges, three professional societies (IMMPACT, ION, INS) convened a meeting to develop consensus recommendations on the design, conduct, analysis, and interpretation of RCTs of SCS for chronic pain. This paper summarizes the results of this meeting. Highlights of our recommendations include disclosing all funding source and potential conflicts; incorporating mechanistic objectives when possible; avoiding non-inferiority designs without internal demonstration of assay sensitivity; achieving and documenting double-blinding whenever possible; documenting investigator and site experience; keeping all information provided to patients balanced with respect to expectation of benefit; disclosing all information provided to patients, including verbal scripts; using placebo/sham controls when possible; capturing a complete set of outcome assessments; accounting for ancillary pharmacologic and non-pharmacologic treatments in a clear manner; providing a complete description of intended and actual programming interactions; making a prospective ascertainment of SCS-specific safety outcomes; training patients and researchers on appropriate expectations, outcome assessments, and other key aspects of study performance; and providing transparent and complete reporting of results according to applicable reporting guidelines.

10.
Biology (Basel) ; 9(8)2020 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-32823649

RESUMO

Type 2 diabetes mellitus (T2DM) is a multifactorial disease associated with many genetic polymorphisms; among them is the FokI polymorphism in the vitamin D receptor (VDR) gene. In this case-control study, samples from 82 T2DM patients and 82 healthy controls were examined to investigate the association of the FokI polymorphism and lipid profile with T2DM in the Jordanian population. DNA was extracted from blood and genotyped for the FokI polymorphism by polymerase chain reaction (PCR) and DNA sequencing. Lipid profile and fasting blood sugar were also measured. There were significant differences in high-density lipoprotein (HDL) cholesterol and triglyceride levels between T2DM and control samples. Frequencies of the FokI polymorphism (CC, CT and TT) were determined in T2DM and control samples and were not significantly different. Furthermore, there was no significant association between the FokI polymorphism and T2DM or lipid profile. A feed-forward neural network (FNN) was used as a computational platform to predict the persons with diabetes based on the FokI polymorphism, lipid profile, gender and age. The accuracy of prediction reached 88% when all parameters were included, 81% when the FokI polymorphism was excluded, and 72% when lipids were only included. This is the first study investigating the association of the VDR gene FokI polymorphism with T2DM in the Jordanian population, and it showed negative association. Diabetes was predicted with high accuracy based on medical data using an FNN. This highlights the great value of incorporating neural network tools into large medical databases and the ability to predict patient susceptibility to diabetes.

11.
Anesth Essays Res ; 14(1): 137-142, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32843807

RESUMO

Background: Bariatric surgery is the effective management of obesity; however, postoperative pain is associated with a great morbidity. The management of pain is important for the enhancement of patient recovery. Local anesthetics can be injected during laparoscopic surgery into the peritoneum throughout the ports produced either before the beginning of laparoscopy or before the closure of the wound to reduce postoperative pain. Our aim is to evaluate if there is an additive analgesic effect by the administration of intraperitoneal hydrocortisone with streamed intraperitoneal bupivacaine as a method of postoperative pain relief in laparoscopic bariatric surgeries. Patients and Methods: One hundred patients listed for laparoscopic bariatric surgery were the subject of this study. Patients were randomly allocated into two groups: Group I received 100 mg of 0.5% isobaric bupivacaine plus 20 mL normal saline intraperitoneally and Group II received intraperitoneal 100 mg of 0.5% isobaric bupivacaine + 100 mg hydrocortisone + 20 mL of saline at the end of the laparoscopic procedure. The primary outcome was the Visual Analog Scale (VAS) score for pain. The secondary outcomes were the time of first analgesic request, total opioid requirement, heart rate, and mean blood pressure. Results: VAS showed a significant decrease at 4, 6, and 12 h postoperative in Group II compared to Group I. There was a marked decrease in total meperidine requirement with prolonged time of the first analgesic request in Group II compared to Group I. Conclusion: Intraperitoneal hydrocortisone with bupivacaine had improved postoperative pain relief with a decrease in analgesic requirement.

12.
Prog Neurol Surg ; 35: 75-84, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32726773

RESUMO

Since its original introduction several decades ago, peripheral nerve stimulation (PNS) of the craniofacial region has been traditionally performed using devices intended for spinal cord stimulation applications with inevitably high rate of technical challenges and procedural complications. The lower invasiveness of recently developed wireless neurostimulation systems makes them much better suited for craniofacial applications. Here, we discuss the preliminary clinical data from several published reports and the ongoing multicenter prospective study of wireless PNS in the craniofacial region. Advances in wireless transmission of electrical signals may make wireless neurostimulation even more attractive in the future. Since most of the evidence supporting PNS for facial pain comes from small subsets of the population, case series and case reports, there will need to be larger, randomized controlled trials with cost efficacy analyses in order to validate the role of wireless PNS as the standard of care.

13.
J Hand Surg Am ; 2020 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-32698979

RESUMO

This case report presents an application of peripheral nerve stimulation to the median nerve to treat a patient with intractable pain due to a lipofibromatous hamartoma of the left upper extremity. Ultrahigh-frequency ultrasound was used to determine the boundaries of the hamartoma. The patient then underwent an ultrasound-guided implantation of 2 stimulator electrodes distal to the elbow along the median nerve with stimulation coverage achieved at 1.2 and 1.4 mA, respectively. After an uneventful procedure, the pain score immediately decreased from 9 out of 10 to less than 6 on a numeric rating scale. Two weeks after the procedure, the patient reported substantial pain relief, with an average pain level of 5 to 6 out of 10. Twelve months after implantation, the patient maintained significant pain relief, rating her average pain level as a 4 to 6 out of 10. Placement of a percutaneous peripheral nerve stimulator was safe and effective with no adverse events being reported at the 12-month follow-up.

14.
Int J Spine Surg ; 14(3): 418-425, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32699766

RESUMO

Background: Aggressive vertebral hemangioma is rare, and its management can be very challenging. Methods: In this report, we present the case of a 30-year-old female with a normal twin pregnancy. She had been complaining of midthoracic pain after the seventh month of pregnancy with no other symptoms. Normal delivery was done under spinal anesthesia, but the patient's back pain worsened after the delivery, and she left the hospital on Day 4 with the onset of an unsteady gait. She was seen in the spinal clinic on Day 14, referred by her gynecologist, with a paraparetic presentation that was rapidly worsening. Urgent magnetic resonance imaging (MRI) was done and revealed aggressive hemangioma of T6 with kyphosis and significant cord compression. Results: The patient was admitted and was operated the following morning. Posterior decompression with fixation from T4 to T8 and kyphosis correction was done. Samples from the vertebrae were sent to the lab for pathology analysis, and the results confirmed the diagnosis of vertebral hemangioma. She could walk on Day 1 with progressive neurological recovery, but distal junctional kyphosis in the form of a "chance fracture" of T8 occurred at 2 months and was treated conservatively. She showed a satisfactory clinical and radiological result at 2 years with no recurrence. Conclusions: Literature is sparse on the management of vertebral hemangioma in the context of pregnancy and postpartum, with only case reports, and its presentation as a kyphotic fracture is extremely rare. The current case shows how, in the context of delivery, a benign procedure such as spinal anesthesia should be done with extreme caution, as it may play a role in aggravating an undiagnosed aggressive hemangioma; rapid management after the onset of paraparetic symptoms enables a full neurological recovery, but close monitoring later on with regular MRI is mandatory for detection of any recurrence.

15.
J Pain ; 2020 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-32574787

RESUMO

This systematic review assessed design characteristics and reporting quality of published randomized clinical trials of spinal cord stimulation (SCS) for treatment of pain in adults and adolescents. The study protocol was registered with PROSPERO (CRD42018090412). Relevant articles were identified by searching the following databases through December 31, 2018: MEDLINE, Embase, WikiStim, The Cochrane Database of Systematic Reviews, and The Cochrane Central Register of Controlled Trials. Forty-six studies were included. Eighty-seven percent of articles identified a pain-related primary outcome. Secondary outcomes included physical functioning, health-related quality of life, and reductions in opioid use. Nineteen of the 46 studies prespecified adverse events as an outcome, with 4 assessing them as a primary outcome. Eleven studies stated that they blinded participants. Of these, only 5 were assessed as being adequately blinded. The number of participants enrolled was generally low (median 38) and study durations were short (median 12 weeks), particularly in studies of angina. Fifteen studies employed an intention-to-treat analysis, of which only seven specified a method to accommodate missing data. Review of these studies identified deficiencies in both reporting and methodology. The review's findings suggest areas for improving the design of future studies and increasing transparency of reporting. PERSPECTIVE: This article presents a systematic review of research methods and reporting quality of randomized clinical trials of SCS for the treatment of various pain complaints. The review identifies deficiencies in both methodology and reporting, which may inform the design of future studies and improve reporting standards.

16.
Pain Med ; 21(9): 1921-1928, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32393970

RESUMO

OBJECTIVE: Targeted intrathecal drug delivery (TIDD) is an effective interventional pain management modality often used in postlaminectomy patients with refractory chronic low back pain. A combination of intrathecal bupivacaine with an opioid is often used. However, intrathecal catheter tip granulomas have occurred with use of morphine or hydromorphone but generally not with fentanyl. The objective of this study was to compare the efficacy of TIDD using bupivacaine/fentanyl vs bupivacaine/hydromorphone in patients with chronic intractable low back pain postlaminectomy. MATERIALS AND METHODS: A retrospective comparative analysis of consecutive patients with lumbar postlaminectomy syndrome who were trialed and later received TIDD with a combination of bupivacaine/hydromorphone or bupivacaine/fentanyl between June 2009 and May 2016 at a single tertiary medical center. RESULTS: We identified a cohort of 58 lumbar postlaminectomy patients receiving a TIDD admixture of either hydromorphone/bupivacaine (30 patients) or low-dose fentanyl/bupivacaine (28 patients) with at least two years of follow-up. The fentanyl group had significantly lower baseline opioid consumption and a lower rate of intrathecal opioid dose escalation. Both groups had similar and significant reductions in pain scores over the two-year follow-up period. No granulomas were observed. CONCLUSION: TIDD using a low-dose fentanyl admixture with bupivacaine in patients with postlaminectomy syndrome and refractory chronic low back pain results in similar pain relief to TIDD with hydromorphone and bupivacaine. Low-dose intrathecal fentanyl leads to a lower rate of opioid escalation and may be safer than hydromorphone.

17.
Pain Med ; 2020 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-32289829

RESUMO

BACKGROUND: Combining neuraxial opioids and local anesthetics in acute pain results in improved duration of analgesia and reduced dosages and adverse effects. Although commonly used in intrathecal drug delivery systems (IDDS) for chronic pain, the effectiveness of this admixture has not been examined specifically in relation to patient-controlled intrathecal analgesia (PCIA). METHODS: IDDS-implanted chronic noncancer pain patients receiving opioids with bupivacaine (O + B) were randomized to receive either opioids without bupivacaine (O) or O + B in a double-blind manner, at IDDS refills, for one week and then crossed over to the other solution for another week. Primary outcome measures included numeric rating scale (NRS) pain scores before and within 30 minutes after PCIA boluses. Secondary outcome measures included average NRS scores and functional outcome measures. RESULTS: Seventeen patients were enrolled, and 16 patients completed the study. There were no differences in NRS scores before and after PCIA boluses between the O and O + B conditions, though pain scores improved significantly (average decrease in NRS scores: O 1.81 ± 1.47 vs O + B 1.87 ± 1.40, P = 0.688). No differences were noted in speed of onset or duration of analgesia. Although more patients subjectively preferred the O + B treatment, the difference was not statistically significant. No differences were noted in secondary outcome measures, with the exception of global impression of change having higher scores in O compared with O + B. CONCLUSIONS: Acutely removing bupivacaine from a chronic intrathecal infusion of opioids and bupivacaine in patients with chronic noncancer pain did not adversely affect PCIA effectiveness, nor did it affect speed of onset or duration of effect. These findings are divergent from those in acute pain and may have to do with study conditions and pain phenotypes.

18.
Pain Med ; 21(7): 1331-1346, 2020 11 07.
Artigo em Inglês | MEDLINE | ID: mdl-32259247

RESUMO

BACKGROUND: It is nearly impossible to overestimate the burden of chronic pain, which is associated with enormous personal and socioeconomic costs. Chronic pain is the leading cause of disability in the world, is associated with multiple psychiatric comorbidities, and has been causally linked to the opioid crisis. Access to pain treatment has been called a fundamental human right by numerous organizations. The current COVID-19 pandemic has strained medical resources, creating a dilemma for physicians charged with the responsibility to limit spread of the contagion and to treat the patients they are entrusted to care for. METHODS: To address these issues, an expert panel was convened that included pain management experts from the military, Veterans Health Administration, and academia. Endorsement from stakeholder societies was sought upon completion of the document within a one-week period. RESULTS: In these guidelines, we provide a framework for pain practitioners and institutions to balance the often-conflicting goals of risk mitigation for health care providers, risk mitigation for patients, conservation of resources, and access to pain management services. Specific issues discussed include general and intervention-specific risk mitigation, patient flow issues and staffing plans, telemedicine options, triaging recommendations, strategies to reduce psychological sequelae in health care providers, and resource utilization. CONCLUSIONS: The COVID-19 public health crisis has strained health care systems, creating a conundrum for patients, pain medicine practitioners, hospital leaders, and regulatory officials. Although this document provides a framework for pain management services, systems-wide and individual decisions must take into account clinical considerations, regional health conditions, government and hospital directives, resource availability, and the welfare of health care providers.


Assuntos
Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Dor Crônica/terapia , Infecções por Coronavirus/epidemiologia , Glucocorticoides/uso terapêutico , Manejo da Dor/métodos , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Telemedicina , Agendamento de Consultas , Betacoronavirus , Desinfecção , Acesso aos Serviços de Saúde , Humanos , Injeções , Injeções Intra-Articulares , Programas de Rastreamento , Medicina Militar , Pandemias , Equipamento de Proteção Individual , Admissão e Escalonamento de Pessoal , Saúde Pública , Sociedades Médicas , Síndrome de Abstinência a Substâncias/diagnóstico , Triagem , Pontos-Gatilho , Estados Unidos , United States Department of Veterans Affairs
19.
Braz J Biol ; 2020 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-32074169

RESUMO

Plant growth regulators and improved planting density are the innovative techniques in the establishment of more productive cotton crop. A field study was planned to assess the role of growth regulators in the resource utilization efficiency of cotton cultivars under different row spacing at Agronomic Research Area, Bahauddin Zakariya University Multan and Usmania Agricultural Farm, Shujaabad during Kharif 2012. The study was comprised of cotton cultivars viz. CIM-573 and CIM-598, cultivated under conventional (75 cm), medium (50 cm) and improved ultra-narrow row spacing (25 cm) and foliar spray of growth regulators viz. moringa leaf extract (MLE) and mepiquat chloride (MC), either alone or in combination, distilled water as a control. The application of MLE alone and in combination (MLE + MC) showed the promoting effect on crop growth rate, net assimilation rate, leaf area index, leaf area duration, sympodial branches and number of bolls leading to higher seed cotton yield of both cotton cultivars grown under conventional row spacing. While application of MC averts the plant growth without considerably improving the productivity. MLE being rich source of growth promoting hormone and nutrients showed its potential to a far greater extent under conventional row spacing in efficient utilization of available resources compared to MC and distilled water.

20.
J Card Surg ; 35(4): 930-933, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32069370

RESUMO

The indications for extracorporeal membrane oxygenation (ECMO) are expanding. Postobstructive pulmonary edema, also known as negative pressure pulmonary edema, can result in severe respiratory compromise and acute respiratory distress syndrome. We present a case of a 26-year-old female with laryngeal papillomatosis and laryngospasm after direct laryngoscopy, who developed severe NPPE refractory to mechanical ventilator support, which was successfully treated with veno-venous ECMO.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Neoplasias Laríngeas/cirurgia , Papiloma/cirurgia , Complicações Pós-Operatórias/terapia , Edema Pulmonar/terapia , Adulto , Feminino , Humanos , Neoplasias Laríngeas/complicações , Laringismo/complicações , Laringismo/cirurgia , Papiloma/complicações , Pressão , Índice de Gravidade de Doença , Resultado do Tratamento
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