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1.
J Emerg Med ; 2020 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-32536493

RESUMO

BACKGROUND: Flecainide is a class Ic antidysrhythmic agent used to prevent and treat both ventricular and supraventricular tachycardias, including atrial fibrillation, atrioventricular nodal re-entrant tachycardia, and Wolff-Parkinson-White syndrome. Flecainide can cause serious side effects, including cardiac arrest, dysrhythmias, and heart failure. Despite its growing use, the presenting signs and symptoms of flecainide toxicity are not familiar to most clinicians. In particular, our patient's particular presentation of acute kidney injury (AKI) resulting in flecainide accumulation is high risk for missed diagnosis in the emergency department. CASE REPORT: A 58-year-old woman presented with altered mental status and hypoxia that was later found to be secondary to sepsis. Medical history was notable for atrial fibrillation, for which she was on flecainide. Laboratory results were notable for hypokalemia and an AKI. Her wide complex tachycardia on admission was ultimately attributed to flecainide toxicity in the setting of AKI. Six days after presentation, it was found that her flecainide level was in the toxic range at 2.02 µg/mL (normal range 0.20-1.00 µg/mL, toxic >1.50 µg/mL). WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Flecainide intoxication is rare but serious due to the potential for cardiogenic shock. Its diagnosis can be difficult, as the flecainide serum level may take days to result. This case demonstrates the necessity of keeping flecainide toxicity on the physician's differential for patients who are taking the drug, as well as what electrocardiogram findings suggest it as the etiology. Treatment can be lifesaving if initiated promptly.

2.
J Med Toxicol ; 16(3): 255-261, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31898153

RESUMO

INTRODUCTION: Worldwide an estimated one million deaths occur annually as a result of poisoning. Internationally there is a lack of toxicology training programs, especially in resource poor settings. We developed a one-day, interactive toxicology curriculum for healthcare practitioners in countries lacking clinical toxicology training and evaluated its feasibility and effectiveness for knowledge dissemination. METHODS: GETKIT was developed with 3 sections: didactics, hands on toxicology case lab, and technology clinic. The investigators, who are medical toxicologists,created 23 didactic lectures and 42 workshop cases. All materials were peer reviewed by 5 senior medical toxicologists for content validity. Participants atpilot sites were given pre-course, post-course, and 3-month follow-up tests and surveys. RESULTS: GETKIT was delivered internationally at 7 sites between November 2017 and April 2018. There were 186 total participants. One hundred and ten participants (59%) reported their hospital lacked a clinical toxicology service. The median post course score 12 (60%), IQR (6,14) was significantly higher compared to the pre-course score 9 (45%), IQR (6,11) (p < 0.0001). There was a significantly higher median 3-month post course score 13 (65%), IQR (8,14) vs. a median pre course score of 9 (45%), IQR (6,11) (p 0.0005). At 3-month follow up 86% of participants reported GETKIT had changed their clinical practice. CONCLUSIONS: An improvement in and retention of medical toxicology knowledge was demonstrated with the GETKIT course. It also conferred improvement in selfreportedpoisoning management practices in participants from low resource settings.

3.
Prehosp Disaster Med ; 34(4): 385-392, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31280729

RESUMO

BACKGROUND: The Global Terrorism Database (GTD) is an open-source database on terrorist incidents around the world since 1970, and it is maintained by the National Consortium for the Study of Terrorism and Responses to Terrorism (START; College Park, Maryland USA), a US Department of Homeland Security Center of Excellence. The consortium reviews media reports to determine if an event meets eligibility to be categorized as a terrorism incident for entry into the database. OBJECTIVE: The objective of this study was to characterize chemical terrorism incidents reported to the GTD and understand more about the kinds of chemical agents used, the associated morbidity and mortality, the geography of incidents, and the intended targets. METHODS: Chemical terrorism incidents from 1970 through 2015 were analyzed by chemical agent category, injury and fatality, geographic region, and target. RESULTS: During the study period, 156,772 terrorism incidents were reported to the GTD, of which 292 (0.19%) met the inclusion criteria for analysis as a chemical terrorism incident. The reported chemical agent categories were: unknown chemical (30.5%); corrosives (23.3%); tear gas/mace (12.3%); unspecified gas (11.6%); cyanide (8.2%); pesticides (5.5%); metals (6.5%); and nerve gas (2.1%). On average, chemical terrorism incidents resulted in 51 injuries (mean range across agents: 2.5-1,622.0) and seven deaths (mean range across agents: 0.0-224.3) per incident. Nerve gas incidents (2.1%) had the highest mean number of injuries (n = 1,622) and fatalities (n = 224) per incident. The highest number of chemical terrorism incidents occurred in South Asia (29.5%), Western Europe (16.8%), and Middle East/North Africa (13.0%). The most common targets were private citizens (19.5%), of which groups of women (22.8%) were often the specific target. Incidents targeting educational institutions often specifically targeted female students or teachers (58.1%). CONCLUSIONS: Chemical terrorism incidents rarely occur; however, the use of certain chemical terrorism agents, for example nerve gas, can cause large mass-causality events that can kill or injure thousands with a single use. Certain regions of the world had higher frequency of chemical terrorism events overall, and also varied in their frequencies of the specific chemical terrorism agent used. Data suggest that morbidity and mortality vary by chemical category and by region. Results may be helpful in developing and optimizing regional chemical terrorism preparedness activities.


Assuntos
Causas de Morte , Terrorismo Químico/estatística & dados numéricos , Defesa Civil/organização & administração , Planejamento em Desastres/organização & administração , Ferimentos e Lesões/terapia , Vazamento de Resíduos Químicos/estatística & dados numéricos , Gerenciamento de Dados , Bases de Dados Factuais , Feminino , Saúde Global , Humanos , Incidência , Masculino , Medição de Risco , Análise de Sobrevida , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/mortalidade
4.
J Med Toxicol ; 15(3): 198-201, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31062178

RESUMO

Bismuth subsalicylate (BSS) is the active ingredient in over-the-counter antacid and antidiarrheal medications. Coagulopathy in the setting of acetylsalicylic acid toxicity is well documented but not in setting of bismuth subsalicylate overuse. We present a case report of coagulopathy from BSS poisoning in a patient with underlying cirrhosis. The patient's high prothrombin time suggests inhibition of vitamin K-dependent coagulation factors. The patient had decreased factor V activity, which is responsible for converting prothrombin to thrombin. Patients with cirrhosis often have hypoprothrombinemia which may be exacerbated by salicylate-induced coagulopathy. Given the widespread use of BSS products, physicians should recognize coagulopathy as a possible manifestation of toxicity especially in patients with underlying liver disease.

5.
Am J Emerg Med ; 37(1): 143-150, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30355476

RESUMO

INTRODUCTION: Opioid use disorder (OUD) is increasing in prevalence throughout the world, with approximately three million individuals in the United States affected. Buprenorphine is a medication designed, researched, and effectively used to assist in OUD recovery. OBJECTIVE: This narrative review discusses an approach to initiating buprenorphine in the emergency department (ED) for opioid-abuse recovery. DISCUSSION: Buprenorphine is a partial mu-opioid receptor agonist with high affinity and low intrinsic activity. Buprenorphine's long half-life, high potency, and 'ceiling effect' for both euphoric sensation and adverse effects make it an optimal treatment alternative for patients presenting to the ED with opioid withdrawal. While most commonly provided as a sublingual film or tablet, buprenorphine can also be delivered via transbuccal, transdermal, subdermal (implant), subcutaneous, and parenteral routes. Prior to ED administration, caution is recommended to avoid precipitation of buprenorphine-induced opioid withdrawal. Following the evaluation of common opioid withdrawal symptoms, a step-by-step approach to buprenorphine can by utilized to reach a sustained withdrawal relief. A multimodal medication-assisted treatment (MAT) plan involving pharmacologic treatment, as well as counseling and behavioral therapy, is essential to maintaining opioid remission. Patients may be safely discharged with safe-use counseling, close outpatient follow-up, and return precautions for continued management of their OUD. Establishing a buprenorphine program in the ED involves a multifactorial approach to establish a pro-buprenorphine culture. CONCLUSIONS: Buprenorphine is an evidence-based, safe, effective treatment option for OUD in an ED-setting. Though successfully utilized by many ED-based treatment programs, the stigma of 'replacing one opioid with another' remains a barrier. Evidence-based discussions on the safety and benefits of buprenorphine are essential to promoting a culture of acceptance and optimizing ED OUD treatment.


Assuntos
Buprenorfina/uso terapêutico , Serviço Hospitalar de Emergência , Antagonistas de Entorpecentes/uso terapêutico , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Síndrome de Abstinência a Substâncias/tratamento farmacológico , Terapia Comportamental , Buprenorfina/efeitos adversos , Buprenorfina/farmacocinética , Buprenorfina/farmacologia , Terapia Combinada , Aconselhamento Diretivo , Formas de Dosagem , Humanos , Antagonistas de Entorpecentes/efeitos adversos , Antagonistas de Entorpecentes/farmacocinética , Antagonistas de Entorpecentes/farmacologia
7.
J Therm Biol ; 77: 86-95, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30196904

RESUMO

There is evidence that central cholinergic stimulation increases heat dissipation in normotensive rats besides causing changes on the cardiovascular system via modulation of baroreceptors activity. However, the contribution of the central cholinergic system on thermoregulatory responses and its relationship with cardiovascular adjustments in spontaneously hypertensive rats (SHRs), an animal model of reduced baroreceptor sensitivity and thermoregulatory deficit, has not been completely clarified. Therefore, the aim of this study was to verify the involvement of the central cholinergic system in cardiovascular and thermoregulatory adjustments in SHRs. Male Wistar rats (n = 17) and SHRs (n = 17) were implanted with an intracerebroventricular cannula for injections of 2 µL of physostigmine (phy) or saline solution. Tail temperature (Ttail), internal body temperature (Tint), systolic arterial pressure (SAP), heart rate (HR) and metabolic rate were registered during 60 min while the animals remained at rest after randomly receiving the injections. The variability of the SAP and the HR was estimated by the fast Fourier transform. Phy treatment began a succession of cardiovascular and thermoregulatory responses that resulted in increased SAP, reduced HR and increased Ttail in both Wistar and SHRs groups. The magnitude of these effects seems to be more intense in SHRs, since the improvement of heat dissipation reflected in Tint. Taken together, these results provide evidence that hypertensive rats present greater cardiovascular and thermoregulatory responses than normotensive rats after central cholinergic stimulation.


Assuntos
Pressão Sanguínea/efeitos dos fármacos , Regulação da Temperatura Corporal/efeitos dos fármacos , Inibidores da Colinesterase/farmacologia , Frequência Cardíaca/efeitos dos fármacos , Hipertensão/fisiopatologia , Fisostigmina/farmacologia , Animais , Hipertensão/tratamento farmacológico , Hipertensão/metabolismo , Masculino , Pressorreceptores/metabolismo , Ratos Endogâmicos SHR , Ratos Wistar
8.
Trab. educ. saúde ; 16(2): 605-619, maio-ago. 2018. tab
Artigo em Português | LILACS | ID: biblio-962998

RESUMO

Resumo Os agentes comunitários de saúde representam importante elemento na gestão de informações sobre o uso de medicamentos na atenção primária, melhorando a interação da equipe de saúde com a comunidade. O objetivo do estudo foi revelar como o uso de medicamentos está presente na rotina deles e compreender as relações que se estabelecem entre agentes, usuários e equipe. Tratou-se de um estudo qualiquantitativo, com utilização de observação participante, entrevista semiestruturada e grupo focal. Foi desenvolvido em três unidades básicas de saúde em um município de Minas Gerais no período de março de 2013 a fevereiro de 2015. Os resultados revelaram que os agentes se relacionam constantemente com usuários que vivenciam problemas com o uso de medicamentos e apresentam dúvidas sobre suas indicações, efeitos esperados, reações adversas, entre outras. Eles realizam algumas intervenções diretamente com o usuário, porém preferem encaminhar os casos à equipe de saúde. Alguns agentes referiram-se ao farmacêutico como profissional de referência no tocante ao uso de medicamentos, mas a procura por esse profissional mostrou-se baixa pelos sujeitos do estudo. Ressalta-se a importância da formação do agente sobre utilização de medicamentos para instrumentalizá-los no reconhecimento de situações inadequadas, no desenvolvimento de intervenções com a equipe de saúde e no acompanhamento dos usuários.


Abstract The community health agents are an important element in the management of medication information in primary healthcare setting, improving healthcare team interaction with the community. The aim of this study was to reveal how the use of medicines is present in the routine of agentes and understand the relationships established between agents, users and healthcare team. This is a quantitative and qualitative study, using participant observation, semi-structured interview and focus group. This study was conducted at three basic health units in a municipality of Minas Gerais, Brazil, between March, 2013 and February, 2015. The results show that agents constantly relate with patients who experience drug therapy problems and have doubts about the indication, effects, adverse drug reactions, among other. They perform some interventions directly with the patient, but usually they prefer to refer cases to the healthcare team. Some agents said recognizing the pharmacist as a reference on medicines, but the demand for this professional was low by the subjects of this study. We emphasize the importance of the agents training on medication use to instrumentalize them to recognize problematic situations, to develop interventions with the support of the healthcare team and to follow up patients using medicines.


Resumen El agente comunitario de salud representa um elemento importante en la gestión de la información sobre el uso de medicamentos en la atención primaria, mejorando la interacción del equipo de salud con la comunidad. El objetivo de este estudio fue revelar cómo el uso de medicamentos está presente en la rutina de los agentes y entender las relaciones que se establecen entre agentes, usuarios y equipo de salud. Se trata de un estudio cuantitativo y cualitativo, utilizando la observación participante, entrevista semi-estructurada y grupos focales. Lo studio fue desenvolvido en tres unidades básicas de salud en um municipio de Minas Gerais, Brasil, en el período de marzo de 2013 a febrero de 2015. Los resultados muestran que los agentes se relacionan constantemente con usuarios que experimentan problemas con el uso de medicamentos y que tienen dudas acerca de la indicación de medicamentos, los efectos esperados, las reacciones adversas, entre otros. Los agentes realizan algunas intervenciones directamente con el usuario, no obstante prefieren referir los casos para el equipo de salud. Algunos agentes se refieren al farmacéutico como profesional de referencia con respecto al uso de medicamentos, sin embargo, la demanda de estos profesionales por los sujetos de este estudio fue baja. Se resalta la importancia de la formación de los agentes sobre el uso de medicamentos, para darles instrumentos en el reconocimiento de situaciones inadecuadas, el desarrollo de intervenciones con el equipo de salud y el seguimiento de los usuarios.


Assuntos
Humanos , Agentes Comunitários de Saúde , Pesquisa Qualitativa , Uso de Medicamentos
9.
Nutr. clín. diet. hosp ; 38(4): 21-26, 2018. tab
Artigo em Português | IBECS | ID: ibc-180146

RESUMO

Introdução: A adolescência é uma fase da vida, que é caracterizada por várias mudanças, sendo elas, corporais, comportamentais e sociais. Dentro destas mudanças, estão as alimentares, que influenciam no estado nutricional e corporal do indivíduo. Também se deve levar em consideração a forma como o adolescente vê sua imagem corporal. Objetivo: Avaliar o estado nutricional e fazer a análise da satisfação corporal de 371 adolescentes da cidade de AracajuSE, traçando relações com idade, sexo e prática de atividades físicas. Metodologia: O estudo transversal foi realizado em 372 adolescentes, de ambos os sexos, com idade de 10 a 18 anos, em escolas estaduais da cidade de Aracaju-SE. Para a avaliação do estado nutricional, foram feitas as medidas antropométricas, para classificação do IMC e para a análise da satisfação corporal, foi aplicado o Body Shape Questionnaire (BSQ). Resultados: Dos 371 pesquisados, 67,4% estavam em estado eutrófico, representando a maioria. Quanto à satisfação com o estado corporal, de todos pesquisados, 87,9% estavam satisfeitos. Conclusão: Percebeu-se que muitos que estavam em estado nutricional, fora do esperado, estavam satisfeitos com o corpo


Introduction: Adolescence is a phase of life, which is characterized by various changes, being, bodily, behavioral and social. Within these changes, are the alimentary, that influence in the nutritional and corporal state of the individual. Consideration should also be given to how the adolescent sees his or her body image. Objective: To evaluate the nutritional status and analyze the corporal satisfaction of 371 adolescents from the city of Aracaju-SE, drawing relationships with age, sex and physical activity practice. Methods: The cross-sectional study was performed in 371 adolescents of both sexes, aged 10 to 18 years, in state schools in the city of Aracaju-SE. For the assessment of nutritional status, anthropometric measurements were made, for BMI classification and for body satisfaction analysis, the Body Shape Questionnaire (BSQ) was applied. Results: Of the 371 studied, 67.4% were in the eutrophic state, representing the majority. Regarding the satisfaction with body condition, of all surveyed, 87.9% were satisfied. It was noticed that many who were in nutritional status, beyond expected, were satisfied with the body. Conclusion: Many who were in the nutritional state, outside of the expected, were satisfied with the body


No disponible


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Autoimagem , Imagem Corporal/psicologia , Satisfação Pessoal , Estado Nutricional , Avaliação Nutricional , Transtornos Nutricionais/epidemiologia , Estudos Transversais
10.
Nutr. clín. diet. hosp ; 38(1): 46-52, 2018. tab, graf
Artigo em Português | IBECS | ID: ibc-175403

RESUMO

Introdução: A obesidade é um problema de saúde pública que afeta diferentes classes sociais. As pesquisas sobre obesidade vêm enfatizando, sobretudo a distribuição da gordura corporal, pois, quando a obesidade está centralizada na região abdominal as repercussões negativas são mais significativas. Objetivo: Comparar a relação cintura/estatura (RCEst) com outros indicadores de obesidade (Índice de massa corporal (IMC), Índice conicidade (IC) e Circunferência da cintura CC) a fim de identificar o indicador mais sensível para detectar risco cardiovascular em adultos e idosos internados em um Hospital Público de Sergipe. Métodos: O desenho foi de corte transversal, com amostra composta por 136 indivíduos. Foi utilizado o IC, IMC, CC e RCEst, e pontos de corte propostos pela WHO para adultos e Lipschitz para os idosos. Resultados: Os resultados encontrados mostrou que o IC possui uma área sob as curvas ROC de 0,63 e o ponto de corte foi de 1,5 (IC95% = 0,53 - 0,72) com uma sensibilidade de 97% e especificidade de 71%. A CC obteve melhor poder preditivo, com uma área total sob as curvas ROC de 0,83 para homens (IC95% = 0,76 - 0,91). O IMC mostrou-se com especificidade e sensibilidade insatisfatórios quando comparado com a RCEst. Conclusão: Os resultados demonstram que, as áreas sob a curva ROC para identificar o poder preditivo entre os indicadores antropométricos apresentam o Índice de conicidade (IC) e a circunferência da cintura (CC) como melhor discriminadora para adultos e idosos em pacientes hospitalizados considerados fatores de risco para doenças cardiometabólicos


Introduction: Obesity is a public health problem that affects different social classes. Research on obesity has been emphasizing, especially the distribution of body fat, because when obesity is centralized in the abdominal region the negative repercussions are more significant. Objective: To compare the waist/height ratio with other indicators of obesity (body mass index (BMI), conicity index (CI) and waist circumference (WC) in order to identify the most sensitive indicator to detect risk Cardiovascular disease in adults and elderly hospitalized in a Public Hospital of Sergipe. Methods: The design was cross - sectional, with a sample composed of 136 individuals. CI, BMI, WC and RCE, and cutoff points proposed by the WHO for adults and Lipschitz for the elderly were used. Results: The results showed that the CI has an area under the ROC curves of 0.63 and the cutoff point was 1.5 (95% CI = 0.53-0.72) with a sensitivity of 97% and specificity of 71 %. The WC obtained better predictive power, with a total area under the ROC curves of 0.83 for men (95% CI = 0.76-0.91). BMI showed unsatisfactory specificity and sensitivity when compared to RCE. Conclusion: The results show that the areas under the ROC curve to identify the predictive power between the anthropometric indicators present the conicity index (CI) and waist circumference (WC) as the best discriminator for adults and elderly in hospitalized patients considered as risk factors for cardiometabolic diseases


No disponible


Assuntos
Humanos , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Obesidade/complicações , Antropometria/métodos , Fatores de Risco , Biomarcadores/análise , Obesidade/epidemiologia , Hospitalização/estatística & dados numéricos , Razão Cintura-Estatura , Estudos Transversais , Pesos e Medidas Corporais/estatística & dados numéricos , Sobrepeso/epidemiologia
11.
Emerg Med Pract ; 19(3 Suppl Points & Pearls): S1-S2, 2017 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-28745845

RESUMO

Sedative-hypnotic drugs include gamma-Aminobutyric acid (GABA)ergic agents such as benzodiazepines, barbiturates, gamma-Hydroxybutyric acid [GHB], gamma-Butyrolactone [GBL], baclofen, and ethanol. Chronic use of these substances can cause tolerance, and abrupt cessation or a reduction in the quantity of the drug can precipitate a life-threatening withdrawal syndrome. Benzodiazepines, phenobarbital, propofol, and other GABA agonists or analogues can effectively control symptoms of withdrawal from GABAergic agents. Managing withdrawal symptoms requires a patient-specific approach that takes into account the physiologic pathways of the particular drugs used as well as the patient's age and comorbidities. Adjunctive therapies include alpha agonists, beta blockers, anticonvulsants, and antipsychotics. Newer pharmacological therapies offer promise in managing withdrawal symptoms. [Points & Pearls is a digest of Emergency Medicine Practice].


Assuntos
Hipnóticos e Sedativos/efeitos adversos , Síndrome de Abstinência a Substâncias/diagnóstico , Síndrome de Abstinência a Substâncias/fisiopatologia , Anticonvulsivantes/efeitos adversos , Anticonvulsivantes/uso terapêutico , Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Barbitúricos/efeitos adversos , Barbitúricos/uso terapêutico , Benzodiazepinas/efeitos adversos , Benzodiazepinas/uso terapêutico , Diagnóstico Diferencial , Eletrocardiografia/métodos , Agonistas GABAérgicos/efeitos adversos , Agonistas GABAérgicos/uso terapêutico , Humanos , Hipnóticos e Sedativos/farmacocinética , Hipnóticos e Sedativos/uso terapêutico , Infusões Intravenosas/métodos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/fisiopatologia
12.
Acad Psychiatry ; 41(5): 587-591, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28577118

RESUMO

OBJECTIVE: Problem-based learning (PBL) is one of the core components of medical education. To facilitate the spread and use of PBL in child and adolescent psychiatry (CAP) fellowship training, a special interest study group (SISG) was formed at the American Academy of Child and Adolescent Psychiatry (AACAP). Different approaches to the implementation of PBL between programs represented at the SISG are compared in this report. METHODS: The authors distributed a survey to SISG participants after the 2015 annual AACAP meeting, which gathered information about the different approaches programs use to implement PBL in graduate medical education. RESULTS: Six CAP training programs responded to the survey, providing descriptions of the structure and content of PBL seminars. Programs chose to include a wide variety of topics in PBL courses and approach course organization in a number of ways. To the degree that PBL draws from identified reference texts, programs were similar in selecting definitive textbooks, practice parameters, and seminal articles. CONCLUSIONS: This small pilot study is intended to provide a snapshot of the state of PBL implementation in CAP fellowship programs. It reflects that programs can incorporate PBL in a variety of ways, tailored to the needs of the institution. Future directions of research include assessment of resident satisfaction with PBL, impact on resident education, and identifying successful methods of implementation of PBL.


Assuntos
Psiquiatria do Adolescente/educação , Psiquiatria Infantil/educação , Educação de Pós-Graduação em Medicina , Aprendizagem Baseada em Problemas , Adulto , Educação de Pós-Graduação em Medicina/organização & administração , Humanos , Projetos Piloto , Aprendizagem Baseada em Problemas/organização & administração
13.
MMWR Morb Mortal Wkly Rep ; 66(8): 223-226, 2017 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-28253227

RESUMO

Hand sanitizers are effective and inexpensive products that can reduce microorganisms on the skin, but ingestion or improper use can be associated with health risks. Many hand sanitizers contain up to 60%-95% ethanol or isopropyl alcohol by volume, and are often combined with scents that might be appealing to young children. Recent reports have identified serious consequences, including apnea, acidosis, and coma in young children who swallowed alcohol-based (alcohol) hand sanitizer (1-3). Poison control centers collect data on intentional and unintentional exposures to hand sanitizer solutions resulting from various routes of exposure, including ingestion, inhalation, and dermal and ocular exposures. To characterize exposures of children aged ≤12 years to alcohol hand sanitizers, CDC analyzed data reported to the National Poison Data System (NPDS).* The major route of exposure to both alcohol and nonalcohol-based (nonalcohol) hand sanitizers was ingestion. The majority of intentional exposures to alcohol hand sanitizers occurred in children aged 6-12 years. Alcohol hand sanitizer exposures were associated with worse outcomes than were nonalcohol hand sanitizer exposures. Caregivers and health care providers should be aware of the potential dangers associated with hand sanitizer ingestion. Children using alcohol hand sanitizers should be supervised and these products should be kept out of reach from children when not in use.


Assuntos
Ingestão de Alimentos , Etanol/envenenamento , Higienizadores de Mão/envenenamento , Criança , Pré-Escolar , Bases de Dados Factuais , Humanos , Lactente , Recém-Nascido , Centros de Controle de Intoxicações , Envenenamento/epidemiologia , Estados Unidos/epidemiologia
14.
Emerg Med Pract ; 19(3): 1-20, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28186869

RESUMO

Sedative-hypnotic drugs include gamma-Aminobutyric acid (GABA)ergic agents such as benzodiazepines, barbiturates, gamma-Hydroxybutyric acid [GHB], gamma-Butyrolactone [GBL], baclofen, and ethanol. Chronic use of these substances can cause tolerance, and abrupt cessation or a reduction in the quantity of the drug can precipitate a life-threatening withdrawal syndrome. Benzodiazepines, phenobarbital, propofol, and other GABA agonists or analogues can effectively control symptoms of withdrawal from GABAergic agents. Managing withdrawal symptoms requires a patient-specific approach that takes into account the physiologic pathways of the particular drugs used as well as the patient's age and comorbidities. Adjunctive therapies include alpha agonists, beta blockers, anticonvulsants, and antipsychotics. Newer pharmacological therapies offer promise in managing withdrawal symptoms.


Assuntos
Hipnóticos e Sedativos/efeitos adversos , Síndrome de Abstinência a Substâncias/diagnóstico , Procedimentos Clínicos , Diagnóstico Diferencial , Overdose de Drogas/diagnóstico , Overdose de Drogas/reabilitação , Serviços Médicos de Emergência/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Tratamento de Emergência , Humanos , Anamnese/métodos , Exame Físico/métodos , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Gestão de Riscos/métodos , Síndrome de Abstinência a Substâncias/reabilitação
15.
Am J Emerg Med ; 35(5): 802.e7-802.e8, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27884585

RESUMO

According to the NIH, about 275000 patients receive treatment with 5-Fluorouracil (5-FU) and more than 1300 die from 5-FU toxicity every year from life-threatening myelosuppression, gastrointestinal complications, and neurotoxicity. Immunocompromised persons are at higher risk of developing toxicity. Recently uridine triacetate (Vistagard®) has been approved by the Food and Drug Administration (FDA) as the only specific antidote available for 5-FU poisoning. In a clinical trial (n=135), 96% of patients with 5-FU toxicity recovered after treatment, where as in a historical control group only 10% survived. This is the first published case report of survival after 5-FU overdose who also was immunocompromised from HIV/AIDs. A 52year old male with history of HIV/AIDS (CD4 70), CNS toxoplasmosis and anal cancer presented to the emergency department after realizing he had received an entire course of 5-FU in 24 instead of 96h. Treatment with uridine triacetate was arranged in the emergency department. After receiving treatment the patient was asymptomatic and had an uncomplicated hospital course. 5-FU poisoning must be recognized early as uridine triacetate is approved by the FDA for use within 96h following the end of 5-FU administration. Emergency medicine physicians should promptly recognize and treat 5-FU poisoning. However, this may be challenging as patients may not seek medical attention until many hours or several days after last administration since symptoms are often delayed with 5-FU poisoning.


Assuntos
Acetatos/uso terapêutico , Antimetabólitos Antineoplásicos/envenenamento , Neoplasias do Ânus/tratamento farmacológico , Depressão/tratamento farmacológico , Medicina de Emergência , Fluoruracila/envenenamento , Infecções por HIV/tratamento farmacológico , Toxoplasmose Cerebral/tratamento farmacológico , Uridina/análogos & derivados , Antimetabólitos Antineoplásicos/administração & dosagem , Antimetabólitos Antineoplásicos/farmacocinética , Overdose de Drogas , Fluoruracila/administração & dosagem , Fluoruracila/farmacocinética , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Uridina/uso terapêutico
16.
Nutr. clín. diet. hosp ; 37(1): 98-105, 2017. tab
Artigo em Português | IBECS | ID: ibc-180282

RESUMO

Introdução: A ocorrência da desnutrição em pacientes hospitalizados é um problema de saúde pública. Porém, a desnutrição não é o único problema encontrado no ambiente hospitalar, onde a obesidade passou a ser considerada um problema de saúde pública, tão preocupante quanto a desnutrição. Objetivo: Avaliar o estado nutricional dos pacientes hospitalizados correlacionando a presença de anemia a métodos objetivos e subjetivos de avaliação nutricional. Métodos: Estudo transversal, realizado com pacientes adultos e idosos, em um hospital público de Aracaju-SE. Foram coletados dados antropométricos (métodos objetivos e subjetivos) e bioquímicos (hemoglobina). Resultados: Participaram da pesquisa 149 pacientes, dos quais 57% eram do gênero masculino com idade média de 48,88 ± 17,89. 124 pacientes (83,2%) eram anêmicos e a anemia correlacionou-se ao tempo de internação. Os métodos subjetivos foram mais precisos para diagnosticar desnutrição em adultos (ASG) e em idosos (MAN) em relação aos métodos objetivos. Conclusão: Quanto maior o tempo de internação maior o risco nutricional e maior probabilidade em desenvolver anemia. Espera-se que os achados do presente estudo possam contribuir para ampliar a assistência nutricional prestada aos pacientes hospitalizados a fim de evitar o aparecimento ou piora da desnutrição e anemia, reinternamentos e aumento dos custos hospitalares


Introduction: The incidence of malnutrition in hospitalized patients is a public health problem. But malnutrition is not the only problem encountered in the hospital setting, where obesity is now considered a public health problem, as worrying as malnutrition. Objective: To evaluate the nutritional status of hospitalized patients correlating the presence of anemia the objective and subjective methods of nutritional assessment. Methods: Cross-sectional study performed with adult and elderly patients in a public hospital in Aracaju-SE. We collected anthropometric data (objective and subjective methods) and biochemical (hemoglobin). Results: Participants were 149 patients, of whom 57% were male with an average age of 48.88 ± 17.89. 124 patients (83.2%) were anemic and anemia correlated to the length of stay. Subjective methods were more accurate for diagnosing malnutrition in adults (ASG) and the elderly (MAN) in relation to the objective methods. Conclusion: The longer the time of hospitalization greater nutritional risk and more likely to develop anemia. It is hoped that the findings of this study may contribute to enhance the nutritional care provided to hospitalized patients to prevent the onset or worsening of malnutrition and anemia, internments and increased hospital expense


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Anemia/epidemiologia , Avaliação Nutricional , Estado Nutricional , Transtornos Nutricionais/epidemiologia , Brasil/epidemiologia , Desnutrição/epidemiologia , Tempo de Internação/estatística & dados numéricos , Estudos Transversais , Antropometria/instrumentação , Pesos e Medidas Corporais/estatística & dados numéricos
17.
Nutr. clín. diet. hosp ; 37(3): 145-150, 2017. tab
Artigo em Português | IBECS | ID: ibc-167941

RESUMO

Introdução: A anemia é um importante indicador de desnutrição e de ingestão alimentar inadequada podendo afetar pessoas de todas as faixas etárias. Objetivos: Analisar o consumo alimentar por meio do consumo de ferro (Fe), folato (B9 ou ácido fólico) e/ou cianocobalamina (B12), e a associação entre estado nutricional e anemia em pacientes hospitalizados. Métodos: A coleta foi realizada com pacientes institucionalizados adultos e idosos de ambos os sexos, visando averiguar determinantes de anemia nos mesmos, composta por dados clínicos, antropométricos e bioquímicos. Resultados: A amostra totalizou 123 pacientes, e revelou que mais de 80% dos estudados encontravam-se anêmicos. Não foi observada relação entre anemia e estado nutricional dos pacientes. Houve associação entre as vitaminas estudadas e a anemia. O índice de inadequação foi acentuado em todos os nutrientes referidos, destacando o folato (B9) com 93,19%. Conclusão: O resultado retrata que não houve relação do estado nutricional com a anemia, apesar dos índices elevados, porém foi encontrada associação da ingestão alimentar inadequada com a anemia (AU)


Introduction: Anemia is an important indicator of malnutrition and inadequate food intake can affect people of all age groups. Objective: Analyze food consumption through the iron intake (Fe), folate (B9 or folic acid) and / or cyanocobalamin (B12), and the association between nutritional status and anemia in hospitalized patients. Methods: Data collection was conducted with institutionalized adults and elderly patients of both sexes, aiming to investigate determinants of anemia on them, consisting of clinical, anthropometric and biochemical data. Results: The sample comprised 123 patients and found that more than 80% of the examined are anemic. No relationship was found between anemia and nutritional status of patients. There was a correlation between the studied vitamins and anemia. The inadequacy index was accentured in all nutrients mentioned, highlighting folate (B9) with 93.19%. Conclusion: The result depicts that there was no relationship between nutritional status and anemia, despite the high rates, but war correlated the inadequate food intake with anemia (AU)


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Estado Nutricional , Hospitalização/estatística & dados numéricos , Anemia/dietoterapia , Anemia/epidemiologia , Ingestão de Alimentos/fisiologia , Dieta , Micronutrientes/uso terapêutico , Estudos Transversais/métodos , Declaração de Helsinki
18.
Rev. cuba. plantas med ; 21(2): 181-195, abr.-jun. 2016. tab
Artigo em Português | LILACS | ID: lil-788935

RESUMO

Introdução: a Kielmeyera rubriflora Cambess, pertencente à família Clusiacea, é uma planta nativa do Vale do Jequitinhonha em Minas Gerais no Brasil, onde é utilizada na medicina caseira. É conhecida como Pau Santo, Rosa do Campo, Flor de Santa Rita ou Rosa do Cerrado. Entretanto, até o momento não existem dados disponíveis na literatura no que diz respeito a estudos farmacológicos desta espécie. A Kielmeyera coriácea também é uma planta nativa da região e já existem estudos revelando sua ação antidepressiva. Objetivo: avaliar a ação antidepressiva do extrato etanólico das partes aéreas da K. rubriflora em camundongos. Método: o extrato etanólico das partes aéreas foi administrado por v.o. nas doses de 100 mg/kg, 250 mg/kg e 500 mg/kg em camundongos albinos, suíços, machos, com idade entre 9 e 13 semanas, com peso entre 29 e 43 g. Para a investigação dos efeitos antidepressivos foram utilizados os testes de triagem farmacológica comportamental (administração aguda), nado forçado (administração crônica) e suspensão da cauda (administração crônica). Resultados: na triagem farmacológica comportamental, foram detectados efeitos de depressão do sistema nervoso central pela dose de 100 mg/kg e de estímulo do sistema nervoso central nas doses de 250 e 500 mg/kg. No teste da suspensão da cauda houve diminuição dose-dependente, porém não significativa do tempo de imobilidade. No teste de nado forçado houve diminuição significativa do tempo de imobilidade em todas as doses investigadas sugerindo atividade antidepressiva, principalmente na dose de 100 mg/kg. Conclusão: os dados encontrados sugerem ação antidepressiva do extrato etanólico das partes aéreas da K. rubriflora(AU)


Introducción: la Kielmeyera rubriflora Cambess, perteneciente a la familia Clusiaceae, es una planta nativa del Valle de Jequitinhonha, en Minas Gerais en Brasil, donde se utiliza en la medicina popular. Se le conoce como Pau Santo, Rosa do Campo, Flor de Santa Rita o Rosa do Cerrado. Sin embargo, hasta ahora no hay datos disponibles en la literatura con respecto a los estudios farmacológicos de esta especie. La Kielmeyera coriacea es también una planta nativa de la región y ya hay estudios que revelan su acción antidepresiva. Objetivo: evaluar la acción antidepresiva del extracto crudo de las partes aéreas de la K. rubriflora en ratones. Método: el extracto crudo de las partes aéreas se administró v.o. en dosis de 100 mg/kg, 250 mg/kg y 500 mg/kg en ratones albinos, suizos, machos, con edades comprendidas entre 9 y 13 semanas, con un peso entre 29 y 43 g. Para la investigación de los efectos antidepressivos se utilizaron pruebas de screening farmacológico de comportamiento (administración aguda), nado forzado (administración crónica) y suspensión de la cola (administración crónica). Resultados: en el screening farmacológico de comportamiento se detectaron efectos de depresión del sistema nervoso central por la dosis de 100 mg/kg y estimulación del sistema nervoso central con las dosis de 250 y 500 mg/kg. En el ensayo de suspensión de cola hubo una disminución dependiente de la dosis, pero no significativa en el tiempo de inmovilidad. En la prueba de nado forzado hubo una disminución significativa en el tiempo de inmovilidad en todas las dosis investigadas, sugiriendo actividad antidepresiva, en particular a una dosis de 100 mg/kg. Conclusión: los resultados sugieren la acción antidepresiva del extracto crudo de las partes aéreas de la K. rubriflora(AU)


Introduction: The Kielmeyera rubriflora Cambess, belonging to the Clusiaceae family, is a native to the Vale do Jequitinhonha in Minas Gerais in Brazil, where it is used in folk medicine. It is popularly known as Pau Santo, Rosa do Campo, Flor de Santa Rita and Rosa do Cerrado. However, so far there are no data available in the literature on pharmacological studies regarding this species. The Kielmeyera coriácea is also a native plant in the region and there are already studies revealing its antidepressant action. Objective: To evaluate the antidepressant action of the crude extract fron the aerial parts of K. rubriflora in mice. Method: The crude extract from the aerial parts was administered v.o. at doses of 100 mg/kg, 250 mg/kg and 500 mg/kg in albino Swiss, male mice, between 9 and 13 weeks of age, weighing between 29 and 43 g. In order to the investigation of antidepressant effects, the behavioral pharmacological screening (acute administration), forced swimming (chronic administration) and tail suspension (chronic administration) tests were performed. Results: In the behavioral pharmacological screening were detected central nervous system depression effects with the dose of 100mg/kg and central nervous system stimulation with the doses of 250 and 500 mg/kg. In the tail suspension test, a dose-dependent, but not significant, decrease in the immobility time was observed. In the forced swimming test a significantly lower immobility time was observed at all doses investigated, suggesting an antidepressant activity, especially at a dose of 100 mg/kg. Conclusion: The results suggests an antidepressant action of the crude extract fron the aerial parts of K. rubriflora(AU)


Assuntos
Humanos , Clusiaceae/efeitos dos fármacos , Antidepressivos/uso terapêutico , Brasil
19.
Front Physiol ; 7: 106, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27092082

RESUMO

BACKGROUND AND AIMS: Recent studies have proposed that if a severe caloric restriction (SCR) is initiated at the earliest period of postnatal life, it can lead to beneficial cardiac adaptations later on. We investigated the effects of SCR in Wistar rats from birth to adult age on risk factors for cardiac diseases (CD), as well as cardiac function, redox status, and HSP72 content in response to ischemia/reperfusion (I/R) injury. METHODS AND RESULTS: From birth to the age of 3 months, CR50 rats were fed 50% of the food that the ad libitum group (AL) was fed. Food intake was assessed daily and body weight were assessed weekly. In the last week of the SCR protocol, systolic blood pressure and heart rate were measured and the double product index was calculated. Also, oral glucose and intraperitoneal insulin tolerance tests were performed. Thereafter, rats were decapitated, visceral fat was weighed, and blood and hearts were harvested for biochemical, functional, tissue redox status, and western blot analyzes. Compared to AL, CR50 rats had reduced the main risk factors for CD. Moreover, the FR50 rats showed increased cardiac function both at baseline conditions (45% > AL rats) and during the post-ischemic period (60% > AL rats) which may be explained by a decreased cardiac oxidative stress and increased HSP72 content. CONCLUSION: SCR from birth to adult age reduced risk factors for CD, increased basal cardiac function and protected hearts from the I/R, possibly by a mechanism involving ROS.

20.
Rev. bras. hipertens ; 23(2): 34-38, abr.-jun.2016.
Artigo em Português | LILACS | ID: biblio-881157

RESUMO

Fundamentos: O comportamento alimentar da população brasileira sofreu modificações expressivas, com crescimento do número de refeições fora de casa, redução no consumo das leguminosas, raízes e tubérculos e o aumento da aquisição de proteínas e lipídeos de origem animal, o que, associado a outros fatores, tem contribuído para a elevação na prevalência da hipertensão. Objetivo: Avaliar a ingestão de nutrientes com participação na regulação da Pressão Arterial (PA) em uma amostra de pacientes hipertensos hospitalizados. Materiais e Métodos: Estudo transversal, realizado com pacientes hipertensos hospitalizados, adultos e idosos. Foi usado Recordatório Alimentar de 24 horas (R24h) como inquérito alimentar nesses pacientes. Os macronutrientes foram avaliados por meio da AMDR (Acceptable Macronutrient Distribuition Range ­ Intervalo de Distribuição Aceitável de Macronutrientes) e o potássio (K) e o sódio (Na) por meio da AI (Adequate Intake ­ Ingestão Adequada). Para as inadequações dos nutrientes foi utilizado o método da EAR (Estimated Average Requirement ­ Necessidade Média Estimada). Resultados: Foi observado um reduzido consumo de minerais e vitaminas. A pesquisa também mostrou alta ingestão de carboidratos na maioria dos pacientes (96,36%) associado ao consumo inadequado de cálcio (Ca), zinco (Zn) e magnésio (Mg) em mais de 80% dos pacientes. Conclusão: Quanto melhor a ingestão, maior o impacto benéfico da dieta sobre a PA na população e maior a redução das doenças crônicas não transmissíveis.


Background: The dietary behavior of the Brazilian population has undergone significant changes, with growth in the number of meals outside the home, reducing the consumption of legumes, roots and tubers, and increased acquisition of animal proteins and lipids, which, together with other factors, has contributed to the increased prevalence of hypertension. Objective: To evaluate nutrient intake with participation in the regulation of blood pressure (BP) in a sample of hospitalized hypertensive patients. Materials and Methods: Cross-sectional study, conducted with hospitalized hypertensive patients, adults and seniors. It was used 24 hours Food Recall (24HR) as a dietary survey in these patients. Macronutrients were assessed by AMDR (Acceptable macronutrient distribuition Range) and potassium (K) and sodium (Na) in by AI (Adequate Intake). To the inadequacies of the nutrients we used the EAR method (Estimated Average Requirement ­ Need Estimated Average). Results: Reduced consumption of minerals and vitamins was observed. The research also showed high carbohydrate intake in most patients (96.36%) associated with inadequate intake of calcium (Ca), zinc (Zn) and magnesium (Mg) in over 80% of patients. Conclusion: The higher the intake, the greater the beneficial impact of diet on BP in the population and the greater the reduction of non-transmissible chronic diseases


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Ingestão de Alimentos , Hipertensão , Minerais , Recomendações Nutricionais , Vitaminas
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