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1.
Arq Bras Oftalmol ; 88(2)2024.
Artigo em Inglês | MEDLINE | ID: mdl-39607280

RESUMO

This study aimed to propose a guideline for amblyopia treatment and follow-up. Studies show that amblyopia leads to a series of perceptual deficits, including loss of visual acuity, stereoacuity, and contrast sensitivity. Perceptual changes are also found in the sound eye, such as those involving the types of motion perception. The gold standard of treatment remains the prescription of eyeglasses, when indicated, and patching of the dominant eye. The treatment is mostly effective in patients aged <7 years and must be discontinued gradually, tapering off patching for at least 5 weeks. Atropine may be performed for penalization in hyperopic children whose amblyopic eye has better visual acuity under cycloplegia than the fellow eye. The discovery of significant neural plasticity in the amblyopic brain after the critical period opens possibilities for new treatment modalities even after childhood.


Assuntos
Ambliopia , Acuidade Visual , Humanos , Ambliopia/terapia , Ambliopia/diagnóstico , Ambliopia/fisiopatologia , Brasil , Acuidade Visual/fisiologia , Criança , Óculos , Atropina/uso terapêutico , Atropina/administração & dosagem , Pré-Escolar , Privação Sensorial
2.
Braz J Biol ; 83: e277354, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38452187

RESUMO

This study aimed to explore the diuretic activity of linalyl acetate (LA). LA is an essential oil, it is an integral phyto-constituent of various plants. In this study, acute and chronic diuretic activities were explored by measuring the levels of different electrolytes and pH in the urine of experimental rats. Rats were divided into five groups. The control group was given 10 mg/kg normal saline, the treated group was given 10 mg/kg furosemide, and the remaining 3 groups received different doses of LA including 25, 50, and 75 mg/kg through intraperitoneal route, to determine its diuretic potential. Urine volume for acute diuretic activity was measured for 6 hours however for chronic diuretic activity was measured for 6 days. For a comparative study of LA with a control group and treated group with reference drug, diuretic index was used. Moreover, the underlying mechanism of the diuretic activity was also explored by comparing atropine, L-NAME, and indomethacin. The results of each group with 6 rats in each group were obtained by ± standard error of the mean of every group. Analysis of Variance (ANOVA) was used for statistical analysis. Results revealed that the LA 75 mg/kg dose showed comparable results as of furosemide. Moreover, this study revealed the involvement of muscarinic receptors to produce diuresis in comparison with atropine with very little involvement of prostanoids and no effect on NO pathway induced by indomethacin and L-NAME respectively. It is concluded that LA possess anti-diuretic potential. Muscarinic receptors might be involved in producing diuretic effects.


Assuntos
Diuréticos , Furosemida , Monoterpenos , Ratos , Animais , Furosemida/farmacologia , NG-Nitroarginina Metil Éster/farmacologia , Diuréticos/farmacologia , Indometacina/farmacologia , Atropina/farmacologia , Extratos Vegetais/farmacologia , Receptores Muscarínicos
3.
J Exp Biol ; 227(3)2024 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-38186316

RESUMO

Carnivorous reptiles exhibit an intense metabolic increment during digestion, which is accompanied by several cardiovascular adjustments responsible for meeting the physiological demands of the gastrointestinal system. Postprandial tachycardia, a well-documented phenomenon in these animals, is mediated by the withdrawal of vagal tone associated with the chronotropic effects of non-adrenergic and non-cholinergic (NANC) factors. However, herbivorous reptiles exhibit a modest metabolic increment during digestion and there is no information about postprandial cardiovascular adjustments. Considering the significant impact of feeding characteristics on physiological responses, we investigated cardiovascular and metabolic responses, as well as the neurohumoral mechanisms of cardiac control, in the herbivorous lizard Iguana iguana during digestion. We measured oxygen consumption rate (O2), heart rate (fH), mean arterial blood pressure (MAP), myocardial activity, cardiac autonomic tone, fH/MAP variability and baroreflex efficiency in both fasting and digesting animals before and after parasympathetic blockade with atropine followed by double autonomic blockade with atropine and propranolol. Our results revealed that the peak of O2 in iguanas was reached 24 h after feeding, accompanied by an increase in myocardial activity and a subtle tachycardia mediated exclusively by a reduction in cardiac parasympathetic activity. This represents the first reported case of postprandial tachycardia in digesting reptiles without the involvement of NANC factors. Furthermore, this withdrawal of vagal stimulation during digestion may reduce the regulatory range for short-term fH adjustments, subsequently intensifying the blood pressure variability as a consequence of limiting baroreflex efficiency.


Assuntos
Iguanas , Lagartos , Animais , Atropina/farmacologia , Pressão Sanguínea , Digestão/fisiologia , Frequência Cardíaca/fisiologia , Iguanas/fisiologia , Lagartos/fisiologia , Miocárdio , Taquicardia
4.
Acta Ophthalmol ; 102(3): 364-366, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38131255

RESUMO

Over a century ago, atropine has been tested to arrest myopia progression with good results. In recent years, many randomized clinical trials have tested different concentrations against placebo. Three recent such studies with low-dose atropine showed that it was less effective than previous studies, even the last one showing no difference in myopia progression between the treated and control group. Previous randomized studies had been performed in Asian populations, and these last three were extended to Western Caucasian populations, based on the initial observation that differences in iris pigmentation could be a factor for a difference in effectiveness. We have noticed that the three last studies in the West have used the same patented formulation, while previous studies have preferred compounded low-dose atropine. Here we review how the power of hydrogen (pH) and preservatives could account for differences in drug penetration to the eye, possibly explaining the differences between studies.


Assuntos
Atropina , Miopia , Humanos , Soluções Oftálmicas/uso terapêutico , Progressão da Doença , Miopia/tratamento farmacológico , Concentração de Íons de Hidrogênio , Refração Ocular , Midriáticos
5.
Rev Paul Pediatr ; 42: e2022220, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37937676

RESUMO

OBJECTIVE: The benefit of atropine in pediatric tracheal intubation is not well established. The objective of this study was to evaluate the effect of atropine on the incidence of hypoxemia and bradycardia during tracheal intubations in the pediatric emergency department. METHODS: This is a single-center observational study in a tertiary pediatric emergency department. Data were collected on all tracheal intubations in patients from 31 days to incomplete 20 years old, performed between January 2016 and September 2020. Procedures were divided into two groups according to the use or not of atropine as a premedication during intubation. Records with missing data, patients with cardiorespiratory arrest, cyanotic congenital heart diseases, and those with chronic lung diseases with baseline hypoxemia were excluded. The primary outcome was hypoxemia (peripheral oxygen saturation ≤88%), while the secondary outcomes were bradycardia (decrease in heart rate >20% between the maximum and minimum values) and critical bradycardia (heart rate <60 bpm) during intubation procedure. RESULTS: A total of 151 tracheal intubations were identified during the study period, of which 126 were eligible. Of those, 77% had complex, chronic underlying diseases. Atropine was administered to 43 (34.1%) patients and was associated with greater odds of hypoxemia in univariable analysis (OR: 2.62; 95%CI 1.15-6.16; p=0.027) but not in multivariable analysis (OR: 2.07; 95%CI 0.42-10.32; p=0.37). Critical bradycardia occurred in only three patients, being two in the atropine group (p=0.26). Bradycardia was analyzed in only 42 procedures. Atropine use was associated with higher odds of bradycardia in multivariable analysis (OR: 11.00; 95%CI 1.3-92.8; p=0.028). CONCLUSIONS: Atropine as a premedication in tracheal intubation did not prevent the occurrence of hypoxemia or bradycardia during intubation procedures in pediatric emergency.


Assuntos
Atropina , Bradicardia , Criança , Humanos , Atropina/uso terapêutico , Bradicardia/epidemiologia , Bradicardia/prevenção & controle , Bradicardia/complicações , Serviço Hospitalar de Emergência , Hipóxia/etiologia , Hipóxia/prevenção & controle , Hipóxia/tratamento farmacológico , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/métodos , Lactente , Pré-Escolar , Adolescente
6.
Rev. cuba. oftalmol ; 36(2)jun. 2023.
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1550913

RESUMO

Objetivo: Comparar la efectividad del tratamiento de atropina versus oclusión ocular en pacientes con ambliopía refractiva moderada unilateral. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo de una serie de casos que acudieron a la consulta de Oftalmología Pediátrica del Instituto Cubano de Oftalmología Ramón Pando Ferrer durante el período comprendido de septiembre del 2019 a septiembre de 2021. La muestra quedó conformada por 44 pacientes, los cuales se dividieron de forma aleatoria en dos grupos de estudio, 22 casos al grupo de oclusiones e igual número al grupo de atropina, que cumplían los criterios de inclusión. Se analizaron las variables edad, sexo, defecto refractivo, agudeza visual mejor corregida, sensibilidad al contraste y estereopsis. Resultados: Predominó el astigmatismo hipermetrópico en ambos grupos de estudio. La media de la agudeza visual mejor corregida inicial en ambos grupos fue de 0,4 LogMAR y mejoró a 0,1 LogMAR al finalizar el tratamiento. La media de la sensibilidad al contraste inicial fue de 1,48 (±19,75) para el grupo de oclusiones y de 1,47 (±20,5) para el grupo atropina, al finalizar alcanzaron 1,59 (±10,1) y 1,57 (±10,0) por orden de mención. La estereopsis inicial fue subnormal en ambos grupos, al finalizar el tratamiento fue normal en el 77,3 por ciento grupo oclusión y el 68,2 por ciento grupo atropina. Conclusiones: La efectividad del tratamiento en pacientes con ambliopía refractiva moderada unilateral con atropina es similar a la que se alcanza con la aplicación de la oclusión ocular(AU)


Objective: To compare the effectiveness of atropine treatment versus ocular occlusion in patients with unilateral moderate refractive amblyopia. Methods: A descriptive, longitudinal and prospective study of a series of cases that attended the Pediatric Ophthalmology office of the Ramón Pando Ferrer Cuban Institute of Ophthalmology during the period from September 2019 to September 2021 was carried out. The sample consisted of 44 patients, who were randomly divided into two study groups, 22 cases to the occlusion group and the same number to the atropine group, who met the inclusion criteria. The variables age, gender, refractive defect, best corrected visual acuity, contrast sensitivity and stereopsis were analyzed. Results: Hypermetropic astigmatism predominated in both study groups. Average initial best-corrected visual acuity in both groups was 0.4 LogMAR and improved to 0.1 LogMAR at the end of treatment. Average initial contrast sensitivity was 1.48 (±19.75) for the occlusion group and 1.47 (±20.5) for the atropine group, at completion reaching 1.59 (±10.1) and 1.57 (±10.0) in order of mention. Initial stereopsis was subnormal in both groups, at the end of treatment it was normal in 77.3 percent occlusion group and 68.2 percent atropine group. Conclusions: The effectiveness of treatment in patients with unilateral moderate refractive amblyopia with atropine is similar to that achieved with the application of ocular occlusion(AU)


Assuntos
Humanos , Criança , Atropina/uso terapêutico , Ambliopia/etiologia , Epidemiologia Descritiva , Estudos Longitudinais
7.
Arq Bras Oftalmol ; 87(5): e20220247, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-39298733

RESUMO

PURPOSE: To explore the therapeutic effects of orthokeratology lens combined with 0.01% atropine eye drops on juvenile myopia. METHODS: A total of 340 patients with juvenile myopia (340 eyes) treated from 2018 to December 2020 were divided into the control group (170 cases with 170 eyes, orthokeratology lens) and observation group (170 cases with 170 eyes, orthokeratology lens combined with 0.01% atropine eye drops). The best-corrected distance visual acuity, best-corrected near visual acuity, diopter, axial length, amplitude of accommodation, bright pupil diameter, dark pupil diameter, tear-film lipid layer thickness, and tear break-up time were measured before treatment and after 1 year of treatment. The incidence of adverse reactions was observed. RESULTS: Compared with the values before treatment, the spherical equivalent degree was significantly improved by 0.22 (0.06, 0.55) D and 0.40 (0.15, 0.72) D in the observation and control groups after the treatment, respectively (p<0.01). After the treatment, the axial length was significantly increased by (0.15 ± 0.12) mm and (0.24 ± 0.11) mm in the observation and control groups, respectively, (p<0.01). After the treatment, the amplitude of accommodation significantly declined in the observation group and was lower than that in the control group, whereas both bright and dark pupil diameters significantly increase and were larger than those in the control group (p<0.01). After the treatment, the tear-film lipid layer thickness and tear break-up time significantly declined in the two groups (p<0.01). CONCLUSIONS: Orthokeratology lens combined with 0.01% atropine eye drops can synergistically enhance the control effect on juvenile myopia with high safety.


Assuntos
Atropina , Midriáticos , Miopia , Soluções Oftálmicas , Procedimentos Ortoceratológicos , Acuidade Visual , Humanos , Atropina/administração & dosagem , Atropina/uso terapêutico , Soluções Oftálmicas/administração & dosagem , Miopia/terapia , Miopia/tratamento farmacológico , Procedimentos Ortoceratológicos/métodos , Feminino , Masculino , Criança , Acuidade Visual/efeitos dos fármacos , Adolescente , Resultado do Tratamento , Midriáticos/administração & dosagem , Midriáticos/uso terapêutico , Lágrimas/efeitos dos fármacos , Lágrimas/fisiologia , Acomodação Ocular/efeitos dos fármacos , Comprimento Axial do Olho/efeitos dos fármacos , Refração Ocular/efeitos dos fármacos , Refração Ocular/fisiologia
8.
Physiol Rep ; 10(21): e15474, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36325585

RESUMO

Acetylcholine (ACh) may be involved in the regulation of ovarian functions. A previous systemic study in rats showed that a 4-week, intrabursal local delivery of the ACh-esterase blocker Huperzine-A increased intraovarian ACh levels and changed ovarian follicular development, as evidenced by increased healthy antral follicle numbers and corpora lutea, as well as enhanced fertility. To further characterize the ovarian cholinergic system in the rat, we studied whether innervation may contribute to intraovarian ACh. We explored the cellular distribution of three muscarinic receptors (MRs; M1, M3, and M5), analyzed the involvement of MRs in ovarian steroidogenesis, and examined their roles in ovarian follicular development in normal conditions and in animals exposed to stressful conditions by employing the muscarinic antagonist, atropine. Denervation studies decreased ovarian norepinephrine, but ovarian ACh was not affected, evidencing a local, nonneuronal source of ACh. M1 was located on granulosa cells (GCs), especially in large antral follicles. M5 was associated with the ovarian vascular system and only traces of M3 were found. Ex vivo ovary organo-typic incubations showed that the MR agonist Carbachol did not modify steroid production or expression of steroid biosynthetic enzymes. Intrabursal, in vivo application of atropine (an MR antagonist) for 4 weeks, however, increased atresia of the secondary follicles. The results support the existence of an intraovarian cholinergic system in the rat ovary, located mainly in follicular GCs, which is not involved in steroid production but rather via MRs exerts trophic functions and regulates follicular atresia.


Assuntos
Atresia Folicular , Ovário , Animais , Feminino , Ratos , Ovário/metabolismo , Receptores Muscarínicos/metabolismo , Acetilcolina/fisiologia , Atropina/farmacologia , Antagonistas Muscarínicos/farmacologia , Esteroides/metabolismo
9.
Rev. chil. cardiol ; 41(2): 105-110, ago. 2022. ilus
Artigo em Espanhol | LILACS | ID: biblio-1407756

RESUMO

Resumen: El síncope mediado neuralmente es un trastorno causado por un reflejo autónomo anormalmente amplificado que involucra componentes tanto simpáticos como parasimpáticos. Es la causa más frecuente de síncope en personas jóvenes y su tratamiento sigue siendo un desafío, ya que no se ha demostrado que alguna terapia farmacológica prevenga por completo su recurrencia. En los últimos años ha surgido una técnica denominada cardioneuroablación, que consiste en la ablación por radiofrecuencia de los plexos ganglionares (PG) parasimpáticos, con buenos resultados a corto y largo plazo en la prevención de síncope recurrente, según los diferentes grupos de investigación. Presentamos el primer caso en Chile de un hombre joven con síncopes mediados neuralmente recurrentes que fue tratado con esta técnica en el Hospital Regional de Concepción.


Abstract: Cardioneuroablation is a novel method that can be used to treat reflex syncope. Although the experience with this technique is relatively limited it provides a more physiological way to treat this condition. The first case in Chile is herein reported along with a discussion of the subject.


Assuntos
Humanos , Masculino , Adulto , Técnicas de Ablação/métodos , Ablação por Radiofrequência/métodos , Atropina/farmacologia , Síncope Vasovagal/diagnóstico , Eletrocardiografia/instrumentação
10.
Animal Model Exp Med ; 5(3): 266-273, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35277950

RESUMO

BACKGROUND: The objective of this study was to validate an animal model for dry eye during and after the administration of 1% ophthalmic atropine sulfate (OAS) in New Zealand white (NZW) rabbits. METHODS: OAS (1%) was applied three times per day to 30 eyes of 15 healthy NZW rabbits. Sacrifice, enucleation, and lacrimal gland removal took place on days 15, 21, and 30 (OAS group). A second group (n = 5) was used as control. Clinical evaluations took place on days 3, 10, 15, 18, 21, 24 and 30. The primary endpoints were: Schirmer I test, tear break-up time (TBUT), and corneal fluorescein staining. As secondary endpoints, clinical changes including intraocular pressure, and histopathology were evaluated. RESULTS: While OAS was administered, the Schirmer I test showed a statistically significant reduction for OAS group versus control (p < 0.001), and versus basal production (p < 0.001). TBUT showed statistically significant differences between groups (days 3 and 10; p = 0.001) and versus basal values (day 3; p < 0.001). Fluorescein staining showed a statistically significant difference (day 3; p = 0.001). The most frequent clinical finding was conjunctival hyperemia (76.9% OAS vs. 20% control). For histopathology, all OAS subjects presented some degree of inflammation (86.7% minimal; 13.3% mild) whereas the control presented only 30% minimal inflammation. Goblet cell density showed no difference. CONCLUSIONS: The effectiveness of the OAS dry eye model in NZW rabbits as reported in previous studies was confirmed, provided that the application of the drug is maintained throughout the intervention; it is not a viable model after OAS administration is suspended.


Assuntos
Síndromes do Olho Seco , Aparelho Lacrimal , Animais , Atropina/farmacologia , Síndromes do Olho Seco/tratamento farmacológico , Fluoresceína , Inflamação , Aparelho Lacrimal/patologia , Coelhos
11.
São Paulo; s.n; 2022.
Tese em Português | Coleciona SUS, Sec. Munic. Saúde SP, HSPM-Producao, Sec. Munic. Saúde SP | ID: biblio-1414288

RESUMO

Introdução: A analgesia epidural oferece uma das formas mais eficazes de alívio da dor durante o trabalho de parto, e em países de alta e média renda, seu uso aumentou nas últimas décadas. A cefaleia pós-punção dural (CPPD) é descrita como uma cefaleia ortostática causada pela baixa pressão do líquido cefalorraquidiano (LCR), geralmente acompanhada de dor cervical, zumbido, alterações na audição, fotofobia e/ou náusea. É uma complicação relativamente frequente após bloqueios neuroaxiais, e pode se apresentar na punção dural que ocorre intencionalmente na raquianestesia, ou não intencionalmente como complicação da anestesia peridural. Objetivo: Por meio de uma revisão de ensaios clínicos publicados nos últimos dez anos, propor um protocolo de tratamento da CPPD para ser aplicado no Hospital do Servidor Público Municipal (HSPM) de São Paulo - SP. Método: Trata-se de um estudo exploratório baseado no método de revisão da literatura com síntese de evidências. A base de dados escolhida para seleção dos artigos foi a PUBMED, utilizando a seguinte estratégia de busca: "post-dural puncture headache"[title]. Foram selecionados ensaios clínicos publicados nos últimos dez anos (2012 - 2022). Resultados: Doze trabalhos foram selecionados, resumidos e apresentados em ordem cronológica de publicação. Além disso, as diretrizes apontadas pelos artigos foram utilizadas para sugerir um protocolo hospitalar no tratamento da CPPD. Conclusão: Segundo os trabalhos consultados, um bom protocolo de tratamento para CPPD começaria pela escolha do tipo de agulha, sendo as mais indicadas a 25S e 25G atraumáticas. Como tratamento farmacológico pós-anestesia para a CPPD temos o uso de teofilina, aminofilina, ondansetrona e dexmedetomidina como opções não invasivas de controle dos sintomas da CPPD, além do bloqueio do gânglio esfenopalatino. Ainda, a associação entre neostigmina e atropina também se mostrou eficaz no tratamento da CPPD. Palavras-Chave: Cefaleia Pós-Punção Dural. Raquianestesia. Anestesiologia.


Assuntos
Humanos , Feminino , Gravidez , Dor , Atropina , Teofilina , Trabalho de Parto , Analgesia Epidural , Pressão do Líquido Cefalorraquidiano , Protocolos Clínicos , Dexmedetomidina , Cefaleia Pós-Punção Dural , Aminofilina , Anestesia , Anestesia Epidural , Raquianestesia , Anestesiologia , Agulhas
12.
Molecules ; 26(18)2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34576975

RESUMO

In rats with polycystic ovary syndrome (PCOS) induced by injection of estradiol valerate (EV), unilateral or bilateral section of the vagus nerve restores ovulatory function in 75% of animals, suggesting that the vagus nerve participates in the development of PCOS. Since the vagus nerve is a mixed nerve through which mainly cholinergic-type information passes, the objective of the present study was to analyze whether acetylcholine (ACh) is involved in the development of PCOS. Ten-day-old rats were injected with 2.0 mg EV, and at 60 days of age, they were microinjected on the day of diestrus in the bursa of the left or right ovary with 100 or 700 mg/kg of ovarian weight atropine, a blocker of muscarinic receptors, and sacrificed for histopathological examination after the surgery. Animals with PCOS microinjected with 100 mg of atropine showed a lack of ovulation, lower serum concentrations of progesterone and testosterone, and cysts. Histology of the ovaries of animals microinjected with 700 mg of atropine showed corpus luteum and follicles at different stages of development, which was accompanied by a lower concentration of progesterone and testosterone. These results allow us to suggest that in animals with PCOS, ACh, which passes through parasympathetic innervation, is an important component in the persistence and development of the pathophysiology.


Assuntos
Acetilcolina , Atropina , Estradiol , Ovário , Síndrome do Ovário Policístico , Síndrome do Ovário Policístico/metabolismo , Síndrome do Ovário Policístico/patologia , Animais , Feminino , Ratos , Acetilcolina/metabolismo , Atropina/farmacologia , Ovário/metabolismo , Ovário/efeitos dos fármacos , Ovário/patologia , Estradiol/análogos & derivados , Estradiol/farmacologia , Testosterona/análogos & derivados , Testosterona/sangue , Progesterona/farmacologia , Ovulação/efeitos dos fármacos , Modelos Animais de Doenças , Folículo Ovariano/metabolismo , Folículo Ovariano/efeitos dos fármacos , Folículo Ovariano/patologia , Ratos Wistar
13.
J Emerg Med ; 60(4): 495-497, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33414048

RESUMO

BACKGROUND: Redotex™ is a Mexican weight-loss supplement that is not U.S. Food and Drug Administration-approved. It consists of the following five ingredients: tri-iodothyronine 75 µg, atropine 0.36 mg, diazepam 8 mg, aloin 16 mg, and d-norpseudoephedrine 50 mg per tablet. There are few case reports with clinically severe ingestions. We report two cases of clinical thyrotoxicosis due to use of Redotex. CASE REPORTS: A 29-year-old woman presented to the emergency department (ED) with anxiety and palpitations. She reported taking Redotex daily for 1 week. Her temperature was 37.1°C, blood pressure (BP) was 166/104 mm Hg, and heart rate (HR) was 140 beats/min. Laboratory analysis was significant for a bicarbonate level of 20 mmol/L (reference 22-29 mmol/L), free T4 0.75 ng/dL (reference 0.93-1.70 ng/dL), and thyroid-stimulating hormone (TSH) 0.05 uIU/mL (reference 0.27-4.20 uIU/mL). She was treated with 2 mg i.v. lorazepam and 20 mg oral propranolol. A 37-year-old woman presented with chest pain, palpitations, and nausea after taking Redotex 1 to 2 tablets daily for 6 weeks. Her HR was 134 beats/min and BP was 130/66 mm Hg. Thyroid function tests on initial presentation showed a TSH of 0.013 uU/mL, free T4 of 0.24 ng/dL, and free T3 of >30 pg/mL. She was treated with propranolol 1 mg i.v. twice per day and 2 doses of lorazepam 1 mg. Both patients had resolution of their symptoms. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: When taken chronically and at recommended doses, Redotex can present with clinically significant T3 thyrotoxicosis. This has not been seen in prior reports.


Assuntos
Tireotoxicose , Redução de Peso , Adulto , Atropina , Diazepam , Combinação de Medicamentos , Ingestão de Alimentos , Emodina/análogos & derivados , Feminino , Humanos , Fenilpropanolamina , Tireotoxicose/induzido quimicamente , Tireotoxicose/diagnóstico , Tireotoxicose/tratamento farmacológico , Tri-Iodotironina
14.
Andes Pediatr ; 92(5): 760-764, 2021 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-35319584

RESUMO

INTRODUCTION: Accidental or intentional intoxication by organophosphates, which are toxic substances that inhibit acetylcholinesterase, constitutes a serious public health problem worldwide, with a greater impact in developing countries. Chronic intoxication during pregnancy with alterations in neurodevelopment and fetal growth has been described. OBJECTIVE: To describe an unusual case of transplacentally acquired organophosphorus poisoning, highlighting the clinical presentation, the management with atropine, and the neurological outcome. CLINICAL CASE: 36-weeks premature newborn, whose mother presented acute intentional organophosphorus poisoning 17 hours before birth. The patient was born by emergency C-section, without respiratory distress, with bradycardia, hypotonia, miosis, and bron- chorrhea, as well as clinical signs and laboratory evidence of acute poisoning, with severe metabolic acidosis, and decreased cholinesterase activity. She required advanced resuscitation, management in the Neonatal Intensive Care Unit with invasive ventilation, inotropes, and repeated doses of atropine. She evolved with left hemiparesis and convulsive syndrome that was treated with phenobarbital. She was discharged at 34 days of life with her mother, under custody and supervision of social and family welfare. Treatment and follow-up were suspended until her first year of life when her custody was transferred to an aunt. In neurological control at 18 months, she presented persistence of hemiparesis and speech-language delay, without new seizures. CONCLUSIONS: Organophosphorus poisoning is very rare in the neonatal period and due to the absence of guidelines for the management of this type of patients its treatment is challenging and must be individualized, multidisciplinary, evaluating the risk and benefit of each intervention.


Assuntos
Intoxicação por Organofosfatos , Acetilcolinesterase , Atropina/uso terapêutico , Colinesterases , Feminino , Humanos , Recém-Nascido , Intoxicação por Organofosfatos/tratamento farmacológico , Organofosfatos , Gravidez
15.
J Pediatr ; 231: 273-277.e3, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33301785

RESUMO

This study followed 173 newborn infants in the PREmedication Trial for Tracheal Intubation of the NEOnate multicenter, double-blind, randomized controlled trial of atropine-propofol vs atropine-atracurium-sufentanil for premedication before nonemergency intubation. At 2 years of corrected age, there was no significant difference between the groups in death or risk of neurodevelopmental delay assessed with the Ages and Stages Questionnaire. Trial registration Clinicaltrials.gov: NCT01490580.


Assuntos
Adjuvantes Anestésicos/administração & dosagem , Anestésicos Combinados/administração & dosagem , Atracúrio/administração & dosagem , Atropina/administração & dosagem , Intubação Intratraqueal , Sistema Nervoso/crescimento & desenvolvimento , Propofol/administração & dosagem , Sufentanil/administração & dosagem , Pré-Escolar , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Recém-Nascido , Masculino , Fatores de Tempo , Resultado do Tratamento
16.
Biomed Chromatogr ; 35(5): e5053, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33314218

RESUMO

Atropine is an antimuscarinic alkaloid identified in Atropa belladonna. In pharmacopeias, percolation is standardized as an extraction method for A. belladonna leaves, along with liquid-liquid extraction as a cleanup procedure and titration as an analytical method for assaying the atropine in the leaves. In this study, a faster, solvent-saving, and more reliable method for quality control of A. belladonna samples was developed. Ultrasound-assisted extraction was proposed and optimized by fractional factorial design followed by Box-Behnken design. For modeling atropine content, the following optimal conditions were established: particle size, 180 µm; percentage methanol in water, 50%; volume of solvent, 15 ml; time of extraction, 60 min; and number of extractions, two. This led to a significant improvement in atropine extraction (P < 0.001). For cleanup, solid-phase extraction was used as an alternative to liquid-liquid extraction, giving similar results, with higher reproducibility. Finally, for the atropine assay, a UPLC method was validated as a substitute for the classic titration method. Taken together, the development of an ultrasound-assisted extraction-solid-phase extraction-UPLC approach allowed the determination of atropine content in A. belladonna leaves in a time- and solvent-saving manner, with high reliability.


Assuntos
Atropa belladonna/química , Atropina/análise , Cromatografia Líquida de Alta Pressão/métodos , Extratos Vegetais/química , Folhas de Planta/química , Extração em Fase Sólida/métodos , Antagonistas Muscarínicos/análise , Solventes/química
17.
J Pediatr ; 229: 141-146, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33068569

RESUMO

OBJECTIVE: To assess the procedural and clinical outcomes associated with the introduction of minimally invasive surfactant therapy (MIST) into standard care at 2 tertiary Australian neonatal intensive care units. STUDY DESIGN: A prospective audit was designed before the introduction of MIST in 2018, with data collected over a period of 18 months. Procedural data were completed by the clinical team performing MIST, including clinical observations, medication use, and adverse events. The audit team collected demographic data and subsequent clinical outcomes from medical records. RESULTS: There were 135 MIST procedures recorded in 122 infants. For the included infants, the median gestation was 302/7 weeks (IQR, 276/7 to 322/7 weeks) and birth weight was 1439 g (IQR, 982-1958 g). During the MIST procedure, desaturation to a peripheral oxygen saturation of <80% was common, occurring in 75.2% of procedures. Other adverse events included need for positive pressure ventilation (10.6%) and bradycardia <100 beats per minute (13.3%). The use of atropine premedication was associated with a significantly lower incidence of bradycardia: 8.6% vs 52.9% (P < .01). Senior clinicians demonstrated higher rates of procedural success. The majority of infants (63.9%) treated with MIST did not require subsequent intubation and mechanical ventilation. CONCLUSIONS: MIST can be successfully introduced in neonatal units with limited experience of this technique. The use of atropine premedication decreases the incidence of bradycardia during the procedure. Success rates can be optimized by limiting MIST to clinicians with greater competence in endotracheal intubation.


Assuntos
Intubação Intratraqueal , Surfactantes Pulmonares/administração & dosagem , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Antiarrítmicos/uso terapêutico , Atropina/uso terapêutico , Austrália/epidemiologia , Bradicardia/etiologia , Bradicardia/prevenção & controle , Auditoria Clínica , Competência Clínica , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Oxigênio/sangue , Respiração com Pressão Positiva/estatística & dados numéricos , Pré-Medicação , Estudos Prospectivos
18.
Acta pediátr. hondu ; 12(2): 1279-1282, oct. 2021-marz. 2022.
Artigo em Espanhol | LILACS, BIMENA | ID: biblio-1435809

RESUMO

La intoxicación por betabloqueadores es una situación clínica de poca frecuencia, estrechamente relacionada con trastornos depresivos mayores, con una prevalencia mayor en mujeres. Los episodios de gravedad relacio- nados a toxicidad por betabloqueadores son clasificados como episodios de moderados a severos. En el caso del carvedilol con un umbral tóxico de 50mg. Caso Clínico: Paciente de 16 años con historia de ingesta de carvedilol en niveles tóxicos y único antecedente depresión ma- yor. Discusión: Los betabloqueadores antagonizan los receptores betaadrenérgicos, la sintomatología relacio- nada con bradicardia e hipotensión es frecuente y puede generar afección a nivel del sistema nervioso central. El tratamiento de emergencia sí se capta al paciente en la primera hora consiste en realizar un lavado gástrico y aplicar carbón activado. Se propone el uso de crista- loides y el uso de epinefrina o norepinefrina como ma- nejo de primera línea, en caso de bradicardias sosteni- das debe considerarse el uso de atropina. Los pacientes asintomáticos deben ser vigilados durante seis horas...(AU)


Assuntos
Humanos , Masculino , Adolescente , Antagonistas Adrenérgicos beta/toxicidade , Carvedilol/toxicidade , Atropina/uso terapêutico , Carvão Vegetal/uso terapêutico
19.
ABC., imagem cardiovasc ; 33(4): eabc110, 20200000.
Artigo em Português | LILACS | ID: biblio-1146299

RESUMO

Fundamento: Durante o ecocardiograma sob estresse com dobutamina, podem ocorrer efeitos adversos e exames inconclusivos. Objetivo: Avaliar em uma grande população geral a segurança e a exequibilidade do ecocardiograma sob estresse com dobutamina. Métodos: Estudo de 10.006 ecocardiogramas sob estresse com dobutamina realizados no período de julho de 1996 a setembro de 2007. A dobutamina foi administrada em quatro estágios (10, 20, 30 e 40 µcg.kg-1.min-1) para pesquisa de isquemia miocárdica e iniciada com 5 µcg.kg- ¹.min-1 apenas na análise de viabilidade miocárdica. A atropina foi iniciada conforme os protocolos vigentes. Foram verificados dados clínicos, hemodinâmicos e efeitos adversos associados ao ecocardiograma sob estresse com dobutamina. Resultados: Durante os ecocardiogramas sob estresse com dobutamina, ocorreu angina típica (8,9%), pico hipertensivo (1,7%), ectopias ventriculares isoladas (31%), taquiarritmia supraventricular (1,89%), fibrilação atrial (0,76%) e taquicardia ventricular não sustentada (0,6%). Os efeitos adversos citados foram mais frequentes nos pacientes com ecocardiogramas sob estresse com dobutamina positivos para isquemia. A desaceleração sinusal paradoxal (0,16%) não ocorreu em ecocardiogramas sob estresse com dobutamina positivo. As três complicações graves ocorreram em ecocardiogramas sob estresse com dobutamina positivos para isquemia. Foram dois casos (0,02%) com fibrilação ventricular e um caso de síndrome coronariana aguda (0,01%). Não houve caso de taquicardia ventricular sustentada, ruptura cardíaca, assistolia ou óbito. Comparados aos exames concluídos, nos inconclusivos, os pacientes usaram menos atropina (81,5% versus 49,9%; p< 0,001) e mais betabloqueador (4,7% versus 19%; p< 0,001), apresentando mais pico hipertensivo (1,1% versus 14,2%; p = 0,0001) e taquicardia ventricular não sustentada (0,5% versus 2,2%; p< 0,001). Conclusão: O ecocardiograma sob estresse com dobutamina realizado de forma apropriada é seguro e apresenta elevada exequibilidade.


Background: Adverse effects and inconclusive results may occur on dobutamine stress echocardiography. Objective: To assess the safety and feasibility of dobutamine stress echocardiography in a large general population. Methods: A total of 10,006 dobutamine stress echocardiographies were performed between July 1996 and September 2007. Dobutamine was administered in four stages (10, 20, 30, and 40 µcg·kg-1·min-1) to research myocardial ischemia starting with 5 µcg·kg- ¹·min-1 to analyze myocardial viability. Atropine administration was initiated according to current protocols. Clinical, hemodynamic, and adverse effect data associated with dobutamine stress echocardiography findings were verified. Results: Typical angina (8.9%), hypertensive peak (1.7%), isolated ventricular ectopias (31%), supraventricular tachyarrhythmia (1.89%), atrial


Assuntos
Humanos , Masculino , Feminino , Idoso , Doença das Coronárias/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Atropina/administração & dosagem , Estudos Retrospectivos , Fatores de Risco , Ecocardiografia sob Estresse/efeitos adversos , Ecocardiografia sob Estresse/efeitos dos fármacos , Dobutamina/administração & dosagem , Dobutamina/efeitos adversos , Eletrocardiografia/métodos , Hipertensão/complicações , Metoprolol/administração & dosagem
20.
Vet. Zoot. ; 27: 1-13, 4 nov. 2020.
Artigo em Português | VETINDEX | ID: vti-33214

RESUMO

A reanimação cérebro-cardio-respiratória na medicina veterinária é uma área que merece bastante estudo e aprimoramento, visto que, na rotina, cada profissional acaba tomando uma conduta diferente. Partindo deste fato, é importante estabelecer o correto diagnóstico da parada e utilizar o que existe de mais recente, se baseando em comprovações científicas, para conseguir o sucesso de sua reversão. O objetivo desta revisão foi compilar tudo o que vem sendo escrito e publicado de mais atual referente ao tema, em pequenos animais, no intuito de mostrar aos médicos veterinários atuantes na área clínica, mecanismos de realizar a melhor conduta possível mediante a parada cárdiorespiratória.(AU)


The brain-cardio-respiratory resuscitation in veterinary medicine is an area that deserves a lot of study and improvement, since in the routine, each professional ends up taking a different course. Starting from this fact, it is important to establish the correct diagnosis of the stop and to use what is of the most recent, based on scientific evidence, to achieve the success of its revertion. The objective of this review was to compile all that has been written and published of the most recent one referring to the subject, in small animals, in order to show to veterinarians working in the clinical area, the mechanisms to perform the best possible behavior through the cardiacarrest.(AU)


La reanimación cerebro-cardio-respiratoria en medicina veterinaria es un área que merece mucho estudio y mejora, ya que, en la rutina, cada profesional termina adoptando un enfoque diferente. En base a este hecho, es importante establecer el diagnóstico correcto de la detención y utilizar el más reciente, basado en evidencia científica, para lograr el éxito de su reversión. El propósito de esta revisión fue recopilar todo lo que se ha escrito y publicado sobre lo último en el tema, en animales pequeños, con el fin de mostrar a los veterinarios que trabajan en el área clínica, los mecanismos para llevar a cabo la mejor conducta posible a través del paro cardiopulmonar.(AU)


Assuntos
Animais , Gatos , Cães , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/veterinária , Parada Cardíaca/veterinária , Epinefrina/uso terapêutico , Vasopressinas/uso terapêutico , Atropina/uso terapêutico
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