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1.
Plast Reconstr Surg ; 146(1): 54e-60e, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32590653

RESUMO

BACKGROUND: The wide-awake local anesthesia no tourniquet (WALANT) technique in hand surgery is gaining popularity. The authors aimed to prospectively analyze the frequency and type of arrhythmias in patients undergoing hand surgery under local anesthesia and to examine whether the addition of adrenaline affects their incidence. METHODS: Adult patients undergoing hand surgery under local anesthesia were randomized into two groups: group 1, local anesthesia with lidocaine and tourniquet; and group 2, local anesthesia with lidocaine and adrenaline (WALANT). Patients with a history of arrhythmias were excluded. Patients were connected to Holter electrocardiographic monitoring before surgery and up until discharge. The records were blindly compared between the groups regarding types of arrhythmias, and frequency and timing relative to injection and tourniquet inflation. RESULTS: One hundred two patients were included between August of 2018 and August of 2019 (age, 59.7 ± 13.6 years; 71 percent women; 51 in each group). No major arrhythmia (ventricular tachycardia, ventricular fibrillation, atrial fibrillation) or arrhythmia-related symptoms were recorded for either group. Minor arrhythmias (including atrial premature beats, ventricular premature beats, and atrial tachycardia) were recorded in 68 patients (66.6 percent), with no statistical difference between the groups. There were three patients with minor arrhythmias during inflation of the tourniquet. Patients in the adrenaline group had 2 percent sinus tachycardia during injection and 4 percent asymptomatic bradyarrhythmias. These findings do not require any further treatment. CONCLUSIONS: The authors' results show that hand operations using WALANT technique in patients with no history of arrhythmia are safe and are not arrhythmogenic; therefore, there is no need for routine perioperative continuous electrocardiographic monitoring. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Agonistas Adrenérgicos beta/efeitos adversos , Anestesia Local/métodos , Arritmias Cardíacas , Epinefrina/efeitos adversos , Mãos/cirurgia , Vasoconstritores/efeitos adversos , Adulto , Idoso , Anestesia Local/efeitos adversos , Arritmias Cardíacas/induzido quimicamente , Arritmias Cardíacas/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
2.
J Anim Sci ; 98(6)2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32428228

RESUMO

Heat stress hinders growth and well-being in livestock, an effect that is perhaps exacerbated by the ß1 agonist ractopamine. Heat stress deficits are mediated in part by reduced feed intake, but other mechanisms involved are less understood. Our objective was to determine the direct impact of heat stress on growth and well-being in ractopamine-supplemented feedlot lambs. Commercial wethers were fed under heat stress (40 °C) for 30 d, and controls (18 °C) were pair-fed. In a 2 × 2 factorial, lambs were also given a daily gavage of 0 or 60 mg ractopamine. Growth, metabolic, cardiovascular, and stress indicators were assessed throughout the study. At necropsy, 9th to 12th rib sections (four-rib), internal organs, and feet were assessed, and sartorius muscles were collected for ex vivo glucose metabolic studies. Heat stress increased (P < 0.05) rectal temperatures and respiration rates throughout the study and reduced (P < 0.05) weight gain and feed efficiency over the first week, ultrasonic loin-eye area and loin depth near the end of the study, and four-rib weight at necropsy. Fat content of the four-rib and loin were also reduced (P < 0.05) by heat stress. Ractopamine increased (P < 0.05) loin weight and fat content and partially moderated the impact of heat stress on rectal temperature and four-rib weight. Heat stress reduced (P < 0.05) spleen weight, increased (P < 0.05) adrenal and lung weights, and was associated with hoof wall overgrowth but not organ lesions. Ractopamine did not affect any measured indicators of well-being. Heat stress reduced (P < 0.05) blood urea nitrogen and increased (P < 0.05) circulating monocytes, granulocytes, and total white blood cells as well as epinephrine, TNFα, cholesterol, and triglycerides. Cortisol and insulin were not affected. Heat stress reduced (P < 0.05) blood pressure and heart rates in all lambs and increased (P < 0.05) left ventricular wall thickness in unsupplemented but not ractopamine-supplemented lambs. No cardiac arrhythmias were observed. Muscle glucose uptake did not differ among groups, but insulin-stimulated glucose oxidation was reduced (P < 0.05) in muscle from heat-stressed lambs. These findings demonstrate that heat stress impairs growth, metabolism, and well-being even when the impact of feed intake is eliminated by pair-feeding and that systemic inflammation and hypercatecholaminemia likely contribute to these deficits. Moreover, ractopamine improved muscle growth indicators without worsening the effects of heat stress.


Assuntos
Transtornos de Estresse por Calor/veterinária , Fenetilaminas/administração & dosagem , Doenças dos Ovinos/etiologia , Agonistas Adrenérgicos beta/administração & dosagem , Agonistas Adrenérgicos beta/efeitos adversos , Agonistas Adrenérgicos beta/farmacologia , Ração Animal/análise , Animais , Composição Corporal/efeitos dos fármacos , Suplementos Nutricionais , Glucose/metabolismo , Resposta ao Choque Térmico , Inflamação/metabolismo , Inflamação/veterinária , Insulina/metabolismo , Masculino , Músculo Esquelético/metabolismo , Fenetilaminas/efeitos adversos , Fenetilaminas/farmacologia , Ovinos , Triglicerídeos/metabolismo , Ganho de Peso/efeitos dos fármacos
4.
Food Funct ; 11(1): 965-976, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31960866

RESUMO

Emerging evidence demonstrates that NLRP3 inflammasome activation, lysosomal dysfunction, and impaired autophagic flux play a crucial role in the pathophysiology of myocardial infarction (MI). Therapeutic strategies targeting NLRP3 activation, lysosomal enzyme release and correcting autophagy have shown beneficial effects in suppressing early inflammatory responses in cardiovascular diseases. Thus, the agents, which inhibit NLRP3 activation and correct lysosome dysfunction and impaired autophagic flux, can be potential drugs for MI. The present study evaluated the effects and elucidated the NLRP3 inflammasome mediated mechanism of α-bisabolol, a dietary sesquiterpene alcohol in a rat model of isoproterenol (ISO)-induced MI. In the present study, male albino Wistar rats were pre- and co-treated with intraperitoneal injection of α-bisabolol (25 mg kg-1) daily for 10 days along with the subcutaneous injection of ISO (85 mg kg-1) at an interval of 24 h for two days (9th and 10th day). ISO injections induced MI as evidenced by the elevated cardiac marker enzyme in serum and altered oxidative stress markers in the total heart and lysosomal fractions. ISO also caused activation of NLRP3 inflammasomes mediating TLR4-NFκB/MAPK signaling pathways and lysosomal dysfunction along with induction and release of proinflammatory cytokines. Interestingly, treatment with α-bisabolol favorably corrected the morphological, histopathological, ultrastructural, biochemical and molecular abnormalities induced by ISO-induced MI in rats. Furthermore, the ultrastructural studies also confirmed the improvement in the autophagic mechanism. The findings of the present study clearly demonstrate that α-bisabolol attenuates oxidative stress and inflammation by inhibiting NLRP3 inflammasome activation and TLR4-NFκB/MAPK signaling pathways along with correcting lysosomal dysfunction and impaired autophagic flux. The underlying pharmacological and molecular mechanism of cardioprotection was attributed to its antioxidant, free radical scavenging and anti-inflammatory properties.


Assuntos
Agonistas Adrenérgicos beta/efeitos adversos , Inflamassomos/metabolismo , Sesquiterpenos Monocíclicos/farmacologia , Infarto do Miocárdio/tratamento farmacológico , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Animais , Anti-Inflamatórios/farmacologia , Antioxidantes/farmacologia , Autofagia , Inflamação , Masculino , Infarto do Miocárdio/induzido quimicamente , NF-kappa B/metabolismo , Estresse Oxidativo , Substâncias Protetoras/farmacologia , Ratos , Ratos Wistar , Receptor 4 Toll-Like/metabolismo
5.
Am J Epidemiol ; 189(8): 779-787, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31971234

RESUMO

Asthma has been reported to be associated with an increased risk of type 1 diabetes mellitus in childhood, but the reasons are unclear. We examined whether the use of antiasthmatic drugs was associated with the development of type 1 diabetes in childhood in a nationwide, register-based case-cohort study. We identified all children who were born January 1, 1995, through December 31, 2008, in Finland and diagnosed with type 1 diabetes by 2010 (n = 3,342). A 10% random sample from each birth-year cohort was selected as a reference cohort (n = 80,909). Information on all dispensed antiasthmatic drugs (Anatomical Therapeutic Chemical classification system code R03) during 1995-2009 was obtained, and associations between the use of antiasthmatic drugs and the development of type 1 diabetes were investigated using time-dependent and time-sequential Cox regression models. Dispensed inhaled corticosteroids and inhaled ß-agonists were associated with an increased risk of type 1 diabetes after adjusting for other antiasthmatic drugs, asthma, sex, and birth decade (hazard ratio = 1.29, 95% confidence interval: 1.09, 1.52, and hazard ratio = 1.22, 95% confidence interval: 1.07, 1.41, respectively). These findings suggest that children using inhaled corticosteroids or inhaled ß-agonists might be at increased risk of type 1 diabetes.


Assuntos
Corticosteroides/efeitos adversos , Agonistas Adrenérgicos beta/efeitos adversos , Antiasmáticos/efeitos adversos , Diabetes Mellitus Tipo 1/induzido quimicamente , Administração por Inalação , Corticosteroides/administração & dosagem , Agonistas Adrenérgicos beta/administração & dosagem , Antiasmáticos/administração & dosagem , Estudos de Casos e Controles , Pré-Escolar , Feminino , Humanos , Masculino
6.
Ann Allergy Asthma Immunol ; 124(3): 254-260, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31862434

RESUMO

BACKGROUND: In asthma, short- and long-acting ß-agonists (SABAs and LABAs) should be used together with inhaled corticosteroids (ICS), and regular use is inappropriate. OBJECTIVE: To assess the relationship between patterns of use of therapy and asthma exacerbations (AEx). METHODS: Patients with asthma (6-40 years) were enrolled in France and the United Kingdom. Prescribing data, computer-assisted telephone interviews (CATIs), and text messages assessed medication use and AEx over a maximum period of 24 months. Generalized linear mixed models provided AEx risks associated with therapy. RESULTS: Among the 908 patients (median age: 20.0 years, 46.6% women, 24.5% children) answering a total of 4248 CATIs over 486 (±235) days, regular (ie, daily) use was more frequent for single LABAs and fixed dose combinations (FDCs) than for single ICS (75.6%, 70.1%, and 65.4% of investigated periods of use, respectively). Regular (ie, daily or almost daily) SABA use was observed for 21.1% of periods of use. Altogether, 265 patients (29.2%) experienced 1 or more AEx. The ORs for AEx risk related to regular vs no use of FDCs, single ICS, and single LABAs were 0.98 (95% CI = [0.73-1.33]), 0.90 (95% CI = [0.61-1.33]), and 1.29 (95% CI = [0.76-2.17]), respectively, after adjustment for cotherapy, sociodemographic, and disease characteristics. The OR was 2.09 (95% CI = [1.36-3.21]) in regular SABA users. CONCLUSION: Inhaled corticosteroids and FDCs were often used intermittently, whereas SABAs and LABAs could be used regularly, and exacerbations were frequent. Compared with non-users, the risk of exacerbation increased moderately under regular use of single LABAs, whereas it doubled, significantly, in regular SABA users, likely in relationship with poor overall asthma control.


Assuntos
Agonistas Adrenérgicos beta/uso terapêutico , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Adolescente , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Agonistas Adrenérgicos beta/administração & dosagem , Agonistas Adrenérgicos beta/efeitos adversos , Adulto , Antiasmáticos/administração & dosagem , Antiasmáticos/efeitos adversos , Asma/diagnóstico , Biomarcadores , Criança , Feminino , Seguimentos , Humanos , Masculino , Razão de Chances , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
7.
Rev Assoc Med Bras (1992) ; 65(11): 1343-1348, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31800894

RESUMO

OBJECTIVE: To evaluate chronological age as a limiting factor to perform the bronchodilator test, determine significant adverse effects of short-acting beta 2 agonists with clinical repercussions, and assess bronchodilator response in extreme-old-age patients who undergo the spirometry test. METHODS: This is a cross-sectional and retrospective study. The sample was extracted from the database (spirometer and respiratory questionnaire) of a pulmonary function service. Patients over 90 years old were included in the research, and we evaluated their bronchodilator response and its significant adverse effects that may have clinical repercussions related to the bronchodilator. RESULTS: A sample of 25 patients aged 92.12 ± 2.22 years (95% CI, 91.20 - 93.04), with a minimum age of 90 years and a maximum of 97 years and a predominance of females with 72% (18/25). The bronchodilator test was performed in 84% (21/25) of the patients. The bronchodilator response was evaluated in 19 of the 21 patients (90.47%) who underwent the bronchodilator test. Two tests did not meet the criteria of acceptability and reproducibility. No clinical adverse effects were observed with the bronchodilator medication (salbutamol) during or after the exam. CONCLUSIONS: Chronological age is not a limiting factor for the bronchodilator test, short-acting beta-2 agonists did not present adverse effects with significant clinical repercussion and were useful in the diagnosis and therapeutic guidance of extreme-old-age patients.


Assuntos
Agonistas Adrenérgicos beta/administração & dosagem , Envelhecimento , Testes de Provocação Brônquica/métodos , Broncodilatadores/administração & dosagem , Espirometria/métodos , Agonistas Adrenérgicos beta/efeitos adversos , Idoso de 80 Anos ou mais , Testes de Provocação Brônquica/efeitos adversos , Broncodilatadores/efeitos adversos , Estudos Transversais , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Espirometria/efeitos adversos
8.
Rev. Assoc. Med. Bras. (1992) ; 65(11): 1343-1348, Nov. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1057074

RESUMO

SUMMARY OBJECTIVE: To evaluate chronological age as a limiting factor to perform the bronchodilator test, determine significant adverse effects of short-acting beta 2 agonists with clinical repercussions, and assess bronchodilator response in extreme-old-age patients who undergo the spirometry test. METHODS: This is a cross-sectional and retrospective study. The sample was extracted from the database (spirometer and respiratory questionnaire) of a pulmonary function service. Patients over 90 years old were included in the research, and we evaluated their bronchodilator response and its significant adverse effects that may have clinical repercussions related to the bronchodilator. RESULTS: A sample of 25 patients aged 92.12 ± 2.22 years (95% CI, 91.20 - 93.04), with a minimum age of 90 years and a maximum of 97 years and a predominance of females with 72% (18/25). The bronchodilator test was performed in 84% (21/25) of the patients. The bronchodilator response was evaluated in 19 of the 21 patients (90.47%) who underwent the bronchodilator test. Two tests did not meet the criteria of acceptability and reproducibility. No clinical adverse effects were observed with the bronchodilator medication (salbutamol) during or after the exam. CONCLUSIONS: Chronological age is not a limiting factor for the bronchodilator test, short-acting beta-2 agonists did not present adverse effects with significant clinical repercussion and were useful in the diagnosis and therapeutic guidance of extreme-old-age patients.


RESUMO OBJETIVOS: Avaliar se idade cronológica é um fator limitante para realizar prova broncodilatadora, determinar efeitos adversos significativos com repercussão clínica dos beta-2 agonistas de curta ação e avaliar a resposta broncodilatadora na espirometria, na velhice extrema. MÉTODOS: Estudo transversal, retrospectivo. Amostra extraída do banco de dados (espirômetro e questionário respiratório) de um serviço de função pulmonar. Incluídos na pesquisa pacientes com ≥90 anos, sendo avaliados a resposta broncodilatadora e efeitos adversos significativos com repercussão clínica ao broncodilatador. RESULTADOS: Amostra de 25 pacientes com idade de 92,12 ± 2,22 anos (IC 95%; 91,20 - 93,04), idade mínima de 90 anos e máxima de 97 anos, predominando o sexo feminino, com 72% (18/25). A prova broncodilatadora foi realizada em 84% (21/25) dos pacientes. A avaliação da resposta ao broncodilatador foi feita em 19 dos 21 pacientes (90,47%) que realizaram a prova broncodilatadora, uma vez que dois desses exames não preencheram os critérios de aceitabilidade e reprodutibilidade. A resposta broncodilatadora foi significativa em 10,52% (2/19) dos pacientes, ambos portadores de pneumopatia obstrutiva. Não foram observados efeitos adversos com repercussão clínica da medicação broncodilatadora (salbutamol) durante ou após sua realização. CONCLUSÕES: A idade cronológica não é um fator limitante para a realização da prova broncodilatadora, os beta-2 agonistas de curta ação não apresentaram efeitos adversos com repercussão clínica significativa e foram bastante úteis para auxiliar no diagnóstico e orientação terapêutica na velhice extrema.


Assuntos
Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Espirometria/métodos , Testes de Provocação Brônquica/métodos , Broncodilatadores/administração & dosagem , Envelhecimento , Agonistas Adrenérgicos beta/administração & dosagem , Espirometria/efeitos adversos , Testes de Provocação Brônquica/efeitos adversos , Broncodilatadores/efeitos adversos , Estudos Transversais , Reprodutibilidade dos Testes , Estudos Retrospectivos , Agonistas Adrenérgicos beta/efeitos adversos
9.
Thorax ; 74(11): 1078-1086, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31383774

RESUMO

BACKGROUND: Switching inhalers to cheaper equivalent products is often advocated as a necessary cost saving measure, yet the impact on patient's health and healthcare utilisation has not been measured. METHODS: We identified asthma and chronic obstructive pulmonary disease (COPD) patients from UK primary care electronic healthcare records between 2000 and 2016. A self-controlled case series was used to estimate incidence rate ratios (IRR); comparing outcome rates during the risk period, 3 months after the exposure (financially motivated switch), and control periods (preswitch and postrisk period). Four outcomes were assessed: disease exacerbation, general practitioner consultation, non-specific respiratory events and adverse-medication events. Medication possession ratio (MPR) was calculated to assess adherence. 2017 National Health Service indicative prices were used to estimate cost differences per equivalent dose. RESULTS: We identified a cohort of 569 901 asthma and 171 231 COPD regular inhaler users, 2% and 6% had been switched, respectively. Inhaler switches between a brand-to-generic inhaler, and all other switches (brand-to-brand, generic-to-generic, generic-to-brand), were associated with reduced exacerbations (brand-to-generic: IRR=0.75, 95% CI 0.64 to 0.88; all other: IRR=0.79, 95% CI 0.71 to 0.88). Gender, age, therapeutic class, inhaler device and inhaler-technique checks did not significantly modify this association (p<0.05). The rate of consultations, respiratory-events and adverse-medication events did not change significantly (consultations: IRR=1.00, 95% CI 0.99 to 1.01; respiratory-events: IRR=0.96, 95% CI 0.95 to 0.97; adverse-medication-events: IRR=1.05, 95% CI 0.96 to 1.15). Adherence significantly increased post-switch (median MPR: pre-switch=54%, post-switch=62%; p<0.001). Switching patients, in the cohort of regular inhaler users, to the cheapest equivalent inhaler, could have saved around £6 million annually. CONCLUSION: Switching to an equivalent inhaler in patients with asthma or COPD appeared safe and did not negatively affect patient's health or healthcare utilisation.


Assuntos
Asma/tratamento farmacológico , Redução de Custos/estatística & dados numéricos , Nebulizadores e Vaporizadores/economia , Nebulizadores e Vaporizadores/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Agonistas Adrenérgicos beta/administração & dosagem , Agonistas Adrenérgicos beta/efeitos adversos , Idoso , Asma/complicações , Asma/economia , Custos e Análise de Custo , Progressão da Doença , Combinação de Medicamentos , Feminino , Medicina Geral/estatística & dados numéricos , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Antagonistas Muscarínicos/administração & dosagem , Antagonistas Muscarínicos/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/economia , Resultado do Tratamento , Reino Unido
10.
Neuromuscul Disord ; 29(7): 517-524, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31201046

RESUMO

Spinal muscular atrophy (SMA) is an autosomal recessive disease caused by homozygous deletions or loss-of-function mutations in SMN1, which result in a degeneration of motor neurons in the spinal cord and brain stem. Even without a randomized placebo-controlled trial, salbutamol has been offered to patients with SMA in the neuromuscular clinics of most of hospitals for many years. We describe the response to salbutamol in 48 patients with SMA type II who were not taking any other medication. We investigate the changes over an eighteen-month period in motor functional scales and we analyze side effects and subjective response to treatment. Our results suggest that oral administration of salbutamol might be helpful in the maintenance of motor function in patients with SMA type II. An apparent beneficial effect was observed in functional scales of children under the age of 6, especially during the first 6 months of therapy. The majority of patients of all ages referred some kind of subjective positive effect associated with therapy intake. Salbutamol seemed safe and was well tolerated without serious side effects.


Assuntos
Agonistas Adrenérgicos beta/efeitos adversos , Agonistas Adrenérgicos beta/uso terapêutico , Albuterol/efeitos adversos , Albuterol/uso terapêutico , Atrofias Musculares Espinais da Infância/tratamento farmacológico , Adolescente , Idade de Início , Criança , Pré-Escolar , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Estudos Longitudinais , Masculino , Movimento , Procedimentos Ortopédicos/estatística & dados numéricos , Estudos Prospectivos , Escoliose/etiologia , Atrofias Musculares Espinais da Infância/fisiopatologia , Resultado do Tratamento , Adulto Jovem
11.
J Bras Nefrol ; 42(2): 250-253, 2019 May 30.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31173041

RESUMO

This study reports a case of a 13-year-old male with a 3-year history of severe and intermittent hypokalemia episodes of unknown origin, requiring admission to the intensive care unit (ICU) for long QT syndrome (LQTS), finally diagnosed of redistributive hypokalemia secondary to the abuse of ß-adrenergic agonists in the context of a probable factitious disorder.


Assuntos
Agonistas Adrenérgicos beta/efeitos adversos , Transtornos Autoinduzidos/diagnóstico , Hipopotassemia/induzido quimicamente , Síndrome do QT Longo/induzido quimicamente , Adolescente , Agonistas Adrenérgicos beta/sangue , Albuterol/sangue , Overdose de Drogas/complicações , Humanos , Hipopotassemia/sangue , Hipopotassemia/psicologia , Síndrome do QT Longo/psicologia , Masculino , Potássio/sangue , Potássio/uso terapêutico , Recidiva
12.
Ter Arkh ; 91(1): 78-83, 2019 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-31090376

RESUMO

AIM: The aim of the study. To estimate the effectiveness of clinical patients register implementation as well as to analyze different treatment and prophylactic programs on chronic obstructive pulmonary disease (COPD) patients' structure. MATERIALS AND METHODS: The COPD patient's register consists of 4257 cases. Spirometrical data were evaluated. Dynamic follow was performed on 567 COPD patients. Bronchodilator's therapy was estimated as well as combined inhaled corticosteroid/ long acting ß2-agonist medications and vaccination against pneumococcal infection. RESULTS: Computer program "Electronic polyclinic" proposed by the authors of this article is effective in precision of diagnostic decision making in cohort study, dynamic follow up after clinical symptoms, evaluation of instrumental and laboratory results, prophylactics and treatment effectiveness, "clinical patients registers" automatic formation using syndrome or nosological principle, checking the COPD patients in the group of those with bronchial obstruction. CONCLUSION: Positive effects of long-acting bronchodilator treatment on COPD exacerbation decreasing and more expressed effect of inhaled corticosteroid/ long acting ß2-agonists were confirmed. More interesting result was influence of vaccination against pneumococcal infection PCV13 (polyvalent conjugated vaccine) on exacerbation frequency and dyspnea severity.


Assuntos
Corticosteroides/administração & dosagem , Agonistas de Receptores Adrenérgicos beta 2/administração & dosagem , Broncodilatadores/administração & dosagem , Corticosteroides/uso terapêutico , Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Agonistas Adrenérgicos beta/efeitos adversos , Agonistas Adrenérgicos beta/uso terapêutico , Broncodilatadores/efeitos adversos , Broncodilatadores/uso terapêutico , Estudos de Coortes , Seguimentos , Humanos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Sistema de Registros , Resultado do Tratamento
13.
Clin Perinatol ; 46(2): 203-213, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31010556

RESUMO

Many conditions that require frequent medication use are common during pregnancy. The purpose of this article is to list some of the most common of these disorders and to discuss the risk to the developing fetus of the medications used most frequently to treat them. Included are drugs used for the treatment of asthma, nausea and vomiting, hyperthyroidism, pain and fever, and depression during pregnancy.


Assuntos
Anormalidades Induzidas por Medicamentos/etiologia , Anormalidades Congênitas/epidemiologia , Complicações na Gravidez/tratamento farmacológico , Anormalidades Induzidas por Medicamentos/prevenção & controle , Acetaminofen/efeitos adversos , Acetaminofen/uso terapêutico , Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Agonistas Adrenérgicos beta/efeitos adversos , Agonistas Adrenérgicos beta/uso terapêutico , Analgésicos não Entorpecentes/efeitos adversos , Analgésicos não Entorpecentes/uso terapêutico , Antiasmáticos/efeitos adversos , Antiasmáticos/uso terapêutico , Antidepressivos/efeitos adversos , Antidepressivos/uso terapêutico , Antieméticos/efeitos adversos , Antieméticos/uso terapêutico , Antitireóideos/efeitos adversos , Antitireóideos/uso terapêutico , Asma/tratamento farmacológico , Transtorno Depressivo/tratamento farmacológico , Feminino , Humanos , Hipertireoidismo/tratamento farmacológico , Antagonistas de Leucotrienos/efeitos adversos , Antagonistas de Leucotrienos/uso terapêutico , Troca Materno-Fetal , Metimazol/uso terapêutico , Êmese Gravídica/tratamento farmacológico , Ondansetron/uso terapêutico , Gravidez , Propiltiouracila/uso terapêutico , Teratogênios
15.
Artigo em Inglês | MEDLINE | ID: mdl-30863037

RESUMO

Introduction: This longitudinal, retrospective cohort study of patients with COPD describes baseline characteristics, adherence, and persistence following initiation of inhaled corticosteroids (ICS)/long-acting ß2-agonists (LABA)/long-acting muscarinic antagonists (LAMA) from multiple inhaler triple therapy (MITT). Methods: Patients aged ≥40 years receiving MITT between January 2012 and September 2015 were identified from the IQVIA™ Real-world Data Adjudicated Claims-USA database. MITT was defined as subjects with ≥1 overlapping days' supply of three COPD medications (ICS, LABA, and LAMA). Adherence (proportion of days covered, PDC) and discontinuation (defined as a gap of 1, 30, 60, or 90 days of supply in any of the three components of the triple therapy) were calculated for each patient over 12 months of follow-up. In addition, analyses were stratified by number of inhalers. Results: In total, 14,635 MITT users were identified (mean age, 62 years). Mean PDC for MITT at 12 months was 0.37%. Mean PDC for the ICS/LABA and LAMA component at 12 months was 49% (0.49±0.31; median, 0.47) and 54% (0.54±0.33; 0.56), respectively. The proportion of adherent patients (PDC ≥0.8) at 12 months was 14% for MITT. Allowing for a 30-day gap from last day of therapy, 86% of MITT users discontinued therapy during follow-up. Conclusion: Patients with COPD had low adherence to and persistence with MITT in a real-world setting. Mean PDC for each single inhaler component was higher than the mean PDC observed with MITT. Reducing the number of inhalers may improve overall adherence to intended triple therapy.


Assuntos
Corticosteroides/administração & dosagem , Agonistas Adrenérgicos beta/administração & dosagem , Broncodilatadores/administração & dosagem , Pulmão/efeitos dos fármacos , Adesão à Medicação , Antagonistas Muscarínicos/administração & dosagem , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Administração por Inalação , Corticosteroides/efeitos adversos , Agonistas Adrenérgicos beta/efeitos adversos , Adulto , Idoso , Broncodilatadores/efeitos adversos , Bases de Dados Factuais , Combinação de Medicamentos , Feminino , Humanos , Seguro Saúde , Estudos Longitudinais , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Antagonistas Muscarínicos/efeitos adversos , Nebulizadores e Vaporizadores , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
16.
Obstet Gynecol Surv ; 74(1): 50-55, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30648727

RESUMO

Importance: Preterm delivery represents an important cause of infant morbidity and mortality. Various tocolytics have been studied with the objective of stopping preterm labor, increasing gestational age at delivery, and preventing complications related to preterm birth. Objective: This review aims to summarize the major classes of tocolytics and review the evidence regarding use of each. Evidence Acquisition: A PubMed search of the following terms was performed to gather relevant data: "tocolytic," "preterm labor," "preterm delivery," "PPROM," "magnesium," "indomethacin," "nifedipine," and "betamimetics." Results: The benefits and risks of nonsteroid anti-inflammatory drugs, calcium channel blockers, magnesium, and betamimetics are reviewed. Calcium channel blockers afford superior outcomes in terms of prolonging gestation and decreasing neonatal morbidity and mortality with the fewest adverse effects. Conclusions and Relevance: Tocolytics, particularly calcium channel blockers, may provide benefit to pregnant women and their infants. Their use should be tailored to the particular clinical circumstances of the patient and used in conjunction with other management strategies (e.g., administration of corticosteroids for fetal lung maturation or magnesium for neuroprotection and transfer to a tertiary medical center). Further research and professional guidelines are needed on optimal use of these agents.


Assuntos
Trabalho de Parto Prematuro/tratamento farmacológico , Nascimento Prematuro/prevenção & controle , Tocólise/métodos , Tocolíticos/administração & dosagem , Agonistas Adrenérgicos beta/administração & dosagem , Agonistas Adrenérgicos beta/efeitos adversos , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Bloqueadores dos Canais de Cálcio/administração & dosagem , Bloqueadores dos Canais de Cálcio/efeitos adversos , Feminino , Ruptura Prematura de Membranas Fetais/tratamento farmacológico , Idade Gestacional , Humanos , Gravidez , Tocolíticos/efeitos adversos
17.
J Asthma ; 56(9): 985-994, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30311821

RESUMO

Objective: Asthma is a common emergency department (ED) presentation. This study examined factors associated with inhaled corticosteroids/long-acting beta-agonist (ICS/LABA) use; and management and outcomes before and after ED presentation. Methods: Secondary analysis of a prospective cohort study; adults treated for acute asthma in Canadian EDs underwent a structured interview before discharge and were followed-up four weeks later. Patients received oral corticosteroids (OCS) at discharge and, at physician discretion, most received ICS or ICS/LABA inhaled agents. Analyses focused on ICS/LABA vs "other" treatment groups at ED presentation. Results: Of 807 enrolled patients, 33% reported receiving ICS/LABA at ED presentation; 62% were female, median age was 31 years. Factors independently associated with ICS/LABA treatment prior to ED presentation were: having an asthma action plan; using an asthma diary/peak flow meter; influenza immunization; not using the ED as usual site for prescriptions; ever using OCS and currently using ICS. Patients were treated similarly in the ED and at discharge; however, relapse was higher in the ICS/LABA group, even after adjustment. Conclusion: One-third of patients presenting to the ED with acute asthma were already receiving ICS/LABA agents; this treatment was independently associated with preventive measures. While ICS/LABA management improves control of chronic asthma, patients using these agents who develop acute asthma reflect higher severity and increased risk of future relapse.


Assuntos
Corticosteroides/administração & dosagem , Agonistas Adrenérgicos beta/administração & dosagem , Antiasmáticos/administração & dosagem , Asma/tratamento farmacológico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Doença Aguda/terapia , Administração por Inalação , Adolescente , Corticosteroides/efeitos adversos , Agonistas Adrenérgicos beta/efeitos adversos , Adulto , Antiasmáticos/efeitos adversos , Asma/diagnóstico , Tomada de Decisão Clínica , Combinação de Medicamentos , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Estudos Prospectivos , Recidiva , Índice de Gravidade de Doença , Adulto Jovem
18.
J Cardiovasc Electrophysiol ; 30(2): 171-177, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30375070

RESUMO

INTRODUCTION: Both isoproterenol (Iso) and adenosine (Ado) are used to induce atrial fibrillation (AF) in the electrophysiology lab. However, the utility of Ado has not been systematically established. OBJECTIVE: The purpose of this study was to compare Ado to Iso for the induction of paroxysmal AF. METHODS: Forty patients (16 women; mean age, 60 ± 12 years) with paroxysmal AF, presenting for ablation were prospectively included of whom 36 (90%) received Ado (18-36 mg) and/or Iso (3-20 µg/min incremental dose) in a randomized order (26 [72%] received both drugs). RESULTS: AF was induced with Iso in 15 of 32 (47%) and with Ado in 12 of 30 (40%) patients (P = 0.9). Iso-triggered AF started from the left pulmonary veins (PVs) in 11 of 15 (73%), from the right PVs in 3 of 15 (20%), and from the coronary sinus (CS) in 1 of 15 (7%) cases. Ado-induced AF episodes originated from the left PVs in 6 of 12 (50%), from the right atrium (RA) in 4 of 12 (33%), and from the CS in 2 of 12 (17%) cases. Altogether, Iso-induced AF was more likely initiated from the PVs (93%) compared with Ado (50%) ( P = 0.02). Ado-induced non-PV triggers were not predictive of arrhythmia recurrence after PV isolation. CONCLUSION: Ado much more frequently induces non-PV triggers, especially from the RA. The clinical significance of these foci, however, is questionable.


Assuntos
Adenosina/administração & dosagem , Agonistas Adrenérgicos beta/administração & dosagem , Fibrilação Atrial/diagnóstico , Seio Coronário/fisiopatologia , Técnicas Eletrofisiológicas Cardíacas , Isoproterenol/administração & dosagem , Veias Pulmonares/fisiopatologia , Agonistas do Receptor Purinérgico P1/administração & dosagem , Potenciais de Ação , Adenosina/efeitos adversos , Agonistas Adrenérgicos beta/efeitos adversos , Idoso , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/cirurgia , Ablação por Cateter , Seio Coronário/cirurgia , Feminino , Frequência Cardíaca , Humanos , Isoproterenol/efeitos adversos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Veias Pulmonares/cirurgia , Agonistas do Receptor Purinérgico P1/efeitos adversos , Reprodutibilidade dos Testes
19.
Mov Disord ; 33(9): 1465-1471, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30311974

RESUMO

BACKGROUND: ß2-adrenoreceptors have recently been identified as regulators of the α-synuclein gene, which is implicated in the pathogenesis of Parkinson's disease. OBJECTIVE: The objectives of this study were to assess the association between use of ß2-agonists and ß-antagonists and the risk of developing PD. METHODS: We conducted a nested case-control study in a cohort of 1,762,164 adults without a diagnosis of PD. They were identified on January, 1, 2004, from the electronic medical records of the largest health care provider in Israel. Participants were followed up until June 30, 2017, for the occurrence of PD. Ten randomly selected controls were matched to each case of PD on age, sex, ethnic group, and duration of follow-up. RESULTS: During follow-up 11,314 patients were newly diagnosed with PD and were matched with 113,140 controls. An increased risk of PD was seen with the use of nonselective ß-antagonists (RR, 2.04 [1.90-2.20]) but not with the use of selective ß1-antagonists (RR, 1.00 [0.95-1.05]). Use of ß2-agonists was associated with reduced risk of PD (RR, 0.89 [0.82-0.96] for short-acting; RR, 0.84 [0.76-0.93] for long-acting; and RR, 0.49 [0.25-0.92] for ultra-long-acting ß2-agonists). In an analysis of individual drugs, propranolol and salbutamol were significantly associated with PD risk, even when these drugs were ascertained 5 years prior to the index date, compared with nonusers (RR, 1.31 [1.08-1.58] and 1.89 {1.53-2.33]) in patients who filled <6 and ≥6 propranolol prescriptions, respectively; the corresponding RRs for salbutamol were 0.95 (0.83-1.08) and 0.65 (0.45-0.94), respectively. CONCLUSIONS: Use of propranolol appears to be associated with an increased risk of PD, whereas use of ß2-agonists is associated with a decreased risk of PD. © 2018 International Parkinson and Movement Disorder Society.


Assuntos
Agonistas Adrenérgicos beta/efeitos adversos , Antagonistas Adrenérgicos beta/efeitos adversos , Doença de Parkinson/epidemiologia , Doença de Parkinson/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Coortes , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
20.
Bull Exp Biol Med ; 165(5): 606-609, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30225718

RESUMO

The contractile function of the heart was studied in adult frogs Rana temporaria under the influence of a toxic dose of isoprenaline under conditions of natural sinoatrial rhythm and during heart pacing. The dynamics of ventricular pressure was recorded with a Prucka MacLab 2000 instrument via a catheter introduced into the ventricle through the ventricular wall. Reduced (p<0.05) parameters of the pump function (HR, maximum ventricular systolic pressure, isovolumic indices dP/dtmax and dP/dtmin) and lengthening of QRS complex and QT interval on ECG attested to impairment of contractile function and electrical processes after exposure to isoprenaline. Electrical stimulation of the right atrium improved myocardial contractility and ECG parameters after the administration of isoprenaline.


Assuntos
Agonistas Adrenérgicos beta/efeitos adversos , Ventrículos do Coração/efeitos dos fármacos , Isoproterenol/efeitos adversos , Contração Miocárdica/efeitos dos fármacos , Pressão Ventricular/efeitos dos fármacos , Animais , Cateteres Cardíacos , Estimulação Elétrica , Eletrocardiografia , Feminino , Frequência Cardíaca/efeitos dos fármacos , Ventrículos do Coração/metabolismo , Ventrículos do Coração/fisiopatologia , Masculino , Miocárdio/metabolismo , Miocárdio/patologia , Rana temporaria , Nó Sinoatrial/efeitos dos fármacos , Função Ventricular/efeitos dos fármacos
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