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1.
J Clin Neurosci ; 71: 271-272, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31889642

RESUMO

A patient with metastatic melanoma developed myasthenia-like syndrome and paraspinal myositis with subsequent extraocular muscle atrophy associated with immune checkpoint inhibitor treatment. MRI scan of the ocular muscles on admission was normal, however 3 months later revealed significant extraocular muscle atrophy.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Melanoma/tratamento farmacológico , Miastenia Gravis/induzido quimicamente , Miosite/induzido quimicamente , Músculos Oculomotores/patologia , Anticorpos Monoclonais Humanizados/efeitos adversos , Atrofia/induzido quimicamente , Humanos , Ipilimumab/efeitos adversos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/induzido quimicamente , Nivolumabe/efeitos adversos , Síndrome
3.
Am J Emerg Med ; 37(11): 2120.e1-2120.e3, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31477355

RESUMO

We present the case of a 25-year-old man with progressive limb weakness. His electrocardiogram showed prominent U waves which made us consider hypokalemia. The final diagnosis was toluene intoxication with severe hypokalemia and metabolic acidosis. Intravenous potassium administration and hydration effectively corrected the electrolyte and acid-base alterations; weakness resolved and the patient was discharged. The approach to a patient with acute weakness can be challenging. This case reminds us that the electrocardiogram can be a valuable tool in the evaluation and differential diagnosis of patients presenting to the emergency department with these conditions.


Assuntos
Acidose/induzido quimicamente , Hipopotassemia/induzido quimicamente , Debilidade Muscular/induzido quimicamente , Solventes/toxicidade , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Tolueno/toxicidade , Acidose/diagnóstico , Adulto , Eletrocardiografia , Humanos , Hipopotassemia/diagnóstico , Masculino , Debilidade Muscular/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/complicações
4.
Anesthesiology ; 131(3): 619-629, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31246607

RESUMO

BACKGROUND: The ideal location for single-injection adductor canal block that maximizes analgesia while minimizing quadriceps weakness after painful knee surgery is unclear. This triple-blind trial compares ultrasound-guided adductor canal block injection locations with the femoral artery positioned medial (proximal adductor canal), inferior (mid-adductor canal), and lateral (distal adductor canal) to the sartorius muscle to determine the location that optimizes postoperative analgesia and motor function. The hypothesis was that distal adductor block has (1) a superior opioid-sparing effect and (2) preserved quadriceps strength, compared with proximal and mid-locations for anterior cruciate ligament reconstruction. METHODS: For the study, 108 patients were randomized to proximal, mid-, or distal adductor canal injection locations for adductor canal block. Cumulative 24-h oral morphine equivalent consumption and percentage quadriceps strength decrease (maximum voluntary isometric contraction) at 30 min postinjection were coprimary outcomes. The time to first analgesic request, pain scores, postoperative nausea/vomiting at least once within the first 24 h, and block-related complications at 2 weeks were also evaluated. RESULTS: All patients completed the study. Contrary to the hypothesis, proximal adductor canal block decreased 24-h morphine consumption to a mean ± SD of 34.3 ± 19.1 mg, (P < 0.0001) compared to 64.0 ± 33.6 and 65.7 ± 22.9 mg for the mid- and distal locations, respectively, with differences [95% CI] of 29.7 mg [17.2, 42.2] and 31.4 mg [21.5, 41.3], respectively, mostly in the postanesthesia care unit. Quadriceps strength was similar, with 16.7%:13.4%:15.3% decreases for proximal:mid:distal adductor canal blocks. The nausea/vomiting risk was also lower with proximal adductor canal block (10 of 34, 29.4%) compared to distal location (23 of 36, 63.9%; P = 0.005). The time to first analgesic request was longer, and postoperative pain was improved up to 6 h for proximal adductor canal block, compared to mid- and distal locations. CONCLUSIONS: A proximal adductor canal injection location decreases opioid consumption and opioid-related side effects without compromising quadriceps strength compared to mid- and distal locations for adductor canal block in patients undergoing anterior cruciate ligament reconstruction.


Assuntos
Analgésicos Opioides/administração & dosagem , Reconstrução do Ligamento Cruzado Anterior , Debilidade Muscular/induzido quimicamente , Músculo Esquelético/efeitos dos fármacos , Bloqueio Nervoso/métodos , Complicações Pós-Operatórias/induzido quimicamente , Adulto , Feminino , Humanos , Masculino , Morfina/administração & dosagem , Complicações Pós-Operatórias/prevenção & controle
5.
J Neurol ; 266(8): 1879-1886, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31049731

RESUMO

INTRODUCTION: Treatment with botulinum toxin A is the evidence-based first-line therapy of cervical dystonia. The aim of this study was to analyze long-term data of the most commonly used products concerning safety and efficacy in a big cohort over decades. METHODS: We retrospectively analyzed the treatment data of all cervical dystonia patients in our outpatient clinic having at least three treatment sessions with current onabotulinumtoxinA or abobotulinumtoxinA. The observation period was up to 17 years for onabotulinumtoxinA and 27 years for abobotulinumtoxinA. We report on safety and efficacy, comparing parameters such as dose, treatment intervals, side effects, occurrence and reasons of primary or secondary non-response. RESULTS: We analyzed a total of 2592 and 6660 treatment sessions in 135 patients with onabotulinumtoxinA, 209 with abobotulinumtoxinA and 10 having received both preparations. We found a moderate increase of dosage in the first years which was succeeded by a stable mean dose (138 and 663 mouse units, respectively) and stable injection intervals from the beginning. The most frequent side effects were mild dysphagia (2/6%), muscle weakness (2/6%) and pain (2/2%). Reasons for therapy discontinuation were change to a nearby doctor, age, other diseases, spontaneous improvement, side effects or possible treatment failure. Of all patients, only two tested positive for neutralizing antibodies against botulinum toxin A. CONCLUSION: We show that treatment of cervical dystonia with the two most frequently used botulinum toxin A preparations is a safe and effective therapy even over a long treatment duration of up to 27 years.


Assuntos
Inibidores da Liberação da Acetilcolina/administração & dosagem , Toxinas Botulínicas Tipo A/administração & dosagem , Duração da Terapia , Torcicolo/diagnóstico , Torcicolo/tratamento farmacológico , Inibidores da Liberação da Acetilcolina/efeitos adversos , Adulto , Toxinas Botulínicas Tipo A/efeitos adversos , Estudos de Coortes , Transtornos de Deglutição/induzido quimicamente , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/induzido quimicamente , Distribuição Aleatória , Estudos Retrospectivos , Resultado do Tratamento
7.
Br J Anaesth ; 123(3): 360-367, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31056239

RESUMO

BACKGROUND: Adductor canal (AC) catheters are being used to provide continuous postoperative analgesia after total knee arthroplasty (TKA) surgery. There are anatomical arguments that most AC catheters are being inserted into the femoral triangle (FT) compartment of the thigh rather than the AC compartment. The clinical relevance of this is unknown with respect to motor weakness, quality of analgesia, and opioid consumption. We hypothesised that AC catheters provide superior functional mobilisation on postoperative Day 1 after TKA as measured using the Timed Up and Go (TUG) test. METHODS: In this multinational, multicentre, double-blinded RCT, catheters were inserted under ultrasound guidance into the anatomical AC and FT compartments. The standardised protocol included spinal anaesthesia without intrathecal morphine, fixed catheter infusion rates, and oral analgesia. RESULTS: Of 151 subjects recruited, 75 were in the AC group and 76 in the FT group. There was no statistically significant difference in TUG on postoperative Day 1 between AC (38 [29-55] s) and FT subjects (44 [32-64] s) (median [inter-quartile range]); P=0.11). There was no difference in TUG Day 2, AC (38 [27-53] s) vs FT (42 [31-59] s); P=0.66. There were no statistically significant differences for secondary endpoints of pain level, effectiveness of pain relief, interference of functional activities and interpersonal relationships by pain, and opioid consumption between groups. CONCLUSIONS: There were no differences in immediate postoperative functional mobility, analgesia, and opioid consumption provided by catheters inserted into the AC vs FT locations for TKA surgery. CLINICAL TRIAL REGISTRATION: ANZCTR12617001421325.


Assuntos
Artroplastia do Joelho/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Idoso , Analgésicos Opioides/administração & dosagem , Raquianestesia , Anestésicos Locais/administração & dosagem , Artroplastia do Joelho/reabilitação , Cateterismo Periférico/métodos , Método Duplo-Cego , Esquema de Medicação , Deambulação Precoce , Feminino , Nervo Femoral/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/induzido quimicamente , Bloqueio Nervoso/efeitos adversos , Manejo da Dor/métodos , Medição da Dor/métodos , Dor Pós-Operatória/etiologia , Cuidados Pós-Operatórios/métodos , Recuperação de Função Fisiológica , Coxa da Perna/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos
8.
BMJ Case Rep ; 12(5)2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31068355

RESUMO

Necrotising autoimmune myopathy (NAM) is an immune-mediated myopathy that may be associated with statin use, malignancy or an autoimmune connective tissue disease, but it can also be idiopathic. Anti-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) myopathy is an extremely rare side effect of statin use, occurring in approximately 2-3 out of every 100 000 patients who use statins. Patients typically present with subacute proximal muscle weakness and creatine kinase levels >10 times the upper limit of normal. The diagnosis is suggested by muscle biopsy showing necrotic fibres with minimal inflammation along with positive anti-HMGCR antibodies. Treatment nearly always requires multiple immunosuppressive agents, the earlier use of which is associated with improved outcomes. Reports of statin-induced NAM leading to heart failure are limited. We present the case of a 69-year-old woman with statin-induced NAM who presented with acute systolic heart failure. Early initiation of high-dose corticosteroids and IVIG resulted in significant improvement in her symptoms.


Assuntos
Anti-Inflamatórios/administração & dosagem , Anticolesterolemiantes/efeitos adversos , Atorvastatina/efeitos adversos , Insuficiência Cardíaca Sistólica/induzido quimicamente , Hidroximetilglutaril-CoA Redutases/efeitos dos fármacos , Metilprednisolona/administração & dosagem , Debilidade Muscular/induzido quimicamente , Doenças Musculares/induzido quimicamente , Idoso , Creatina Quinase , Feminino , Insuficiência Cardíaca Sistólica/fisiopatologia , Humanos , Debilidade Muscular/fisiopatologia , Doenças Musculares/fisiopatologia , Resultado do Tratamento
9.
World Neurosurg ; 125: 409-413, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30822591

RESUMO

BACKGROUND: Botulinum toxin (Botox) has long been used therapeutically to treat a variety of diseases, including migraine headaches, cervical spine dystonia, and chronic cervical spine pain, among many others. Although quite useful, Botox has been reported to cause adverse events, some of which may lead to devastating morbidity. CASE DESCRIPTION: An elderly woman presented with severe neck pain after a motor vehicle collision. She underwent Botox administration to the neck extensor muscles, after which she developed severe cervical kyphotic deformity, a complication previously reported only in patients with a history of cervical fusion. In addition, the patient had a pre-existing cervical spine degenerative disc disease with listhesis resulting in cervical kyphotic deformity and loss of cervical lordosis. CONCLUSIONS: This case illustrates a potential danger of using Botox in the neck of an elderly patient who may have pre-existing cervical spine instability, underlying cervical musculature weakness, and pre-existing cervical kyphosis. It demonstrates the need to evaluate patients who are predisposed to developing cervical kyphotic deformities before offering them Botox treatment.


Assuntos
Toxinas Botulínicas Tipo A/efeitos adversos , Cifose/induzido quimicamente , Fármacos Neuromusculares/efeitos adversos , Paralisia/induzido quimicamente , Acidentes de Trânsito , Idoso , Toxinas Botulínicas Tipo A/administração & dosagem , Vértebras Cervicais , Feminino , Humanos , Injeções Intramusculares , Cifose/cirurgia , Debilidade Muscular/induzido quimicamente , Músculo Esquelético/fisiologia , Cervicalgia/etiologia , Fármacos Neuromusculares/administração & dosagem
12.
Toxins (Basel) ; 11(1)2019 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-30650587

RESUMO

How effective and safe are incobotulinumtoxinA injections in adult patients with lateral epicondylitis refractory to other treatments? In this experimental study, ultrasound-guided incobotulinumtoxinA 10⁻30 U/muscle was injected into extensor carpi ulnaris, extensor digiti minimi, extensor digitorum longus and extensor carpi radialis brevis muscles. Pain (visual analogue scale [VAS], 0 to 10 [no pain to severe pain]) and upper-limb functionality (QuickDASH scale, 0 to 100 [best to worst]), assessed at baseline, 1, 3 and 6 months post-treatment, were analysed using repeated-measures analysis of variance (ANOVA) and Tukey post-hoc tests. Secondary analyses stratifying patient population by sex and baseline VAS were performed. Adverse events were reported. Twenty-four patients (mean [standard deviation] age 46.8 years) were included. Compared with baseline, mean VAS and QuickDASH scores improved at all follow-ups (p < 0.001 and p = 0.001, respectively; repeated-measures ANOVA). Secondary analyses revealed significant differences between baseline and all follow-ups in the group with baseline VAS ≥ 6 and in males and females (all p < 0.05, Tukey post-hoc test). No adverse events, except for the expected third finger weakness, were reported. In conclusion, ultrasound-guided incobotulinumtoxinA injections may be an effective treatment for lateral epicondylitis in the appropriate patient population.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Fármacos Neuromusculares/administração & dosagem , Dor/tratamento farmacológico , Cotovelo de Tenista/tratamento farmacológico , Ultrassonografia , Adulto , Toxinas Botulínicas Tipo A/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/induzido quimicamente , Músculo Esquelético/efeitos dos fármacos , Fármacos Neuromusculares/efeitos adversos , Resultado do Tratamento
13.
Curr Aging Sci ; 11(4): 255-260, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30648531

RESUMO

BACKGROUND: Aging leads to changes in skeletal muscle quantity and quality and is accompanied with increase in body mass and fat mass, whereas fat-free mass either decreases or remains unchanged. The body composition of rodents has been an important factor for clinical trials in the laboratory. Glucocorticoids such as dexamethasone are widely used in clinical medicine, but may induce myopathy, characterized by muscle weakness, atrophy, and fatigue. In animals treated with glucocorticoids, a dose-dependent reduction of body weight has been observed. This weight loss is usually followed by muscle atrophy and a reduction of several muscle proteins, contributing to impaired muscle function. This study was designed to describe changes in body composition and BMC of 22-month-old rats during 10- and 20-day recovery period after 10-day dexamethasone administration. METHOD: Data on body mass, lean body mass, fat mass and bone mineral content of the rats were obtained with dual energy X-ray absorptiometry scan. RESULT: Significant reduction in body mass, lean body mass, fat mass and fast-twitch muscle mass was observed after dexamethasone treatment. Body mass, fat mass and fast-twitch muscle mass stayed decreased during 20 days after terminating the hormone administration; lean body mass reached the preadministration level after 20-day recovery period. There were no significant changes in bone mineral density during the recovery period. Dexamethasone treatment gradually reduced hindlimb grip strength that also stayed decreased during the 20-day recovery period. CONCLUSION: This study demonstrated that a 10-day period of overexprosure to glycocorticoids induced longlasting changes in old rats' body composition and these values did not attain the baseline level even after 20-day recovery period.


Assuntos
Envelhecimento/patologia , Envelhecimento/fisiologia , Composição Corporal/efeitos dos fármacos , Dexametasona/administração & dosagem , Dexametasona/efeitos adversos , Glucocorticoides/administração & dosagem , Glucocorticoides/efeitos adversos , Absorciometria de Fóton , Animais , Densidade Óssea/efeitos dos fármacos , Feminino , Força Muscular/efeitos dos fármacos , Debilidade Muscular/induzido quimicamente , Debilidade Muscular/fisiopatologia , Músculo Esquelético/efeitos dos fármacos , Músculo Esquelético/patologia , Músculo Esquelético/fisiopatologia , Ratos , Ratos Wistar
14.
Neuromuscul Disord ; 29(2): 127-133, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30638612

RESUMO

Cancer immunotherapy has transformed the field of oncology and enabled more effective management of previously refractory neoplasms by activation of the immune response. Upregulation of the immune response may also trigger autoimmune adverse events, including neuromuscular complications. We performed a systematic review of autoimmune neuromuscular complications following immune checkpoint blockade. We searched PubMed database and identified 81 cases described, including 30 cases of myasthenia gravis (MG), 29 cases of neuropathy and 22 cases of myopathy. Most patients (89%) developed neuromuscular complications within 3 months from starting immune checkpoint blockade and 40% of all patients had elevated serum CK>1000 IU/L (typical normal <200). Guillain-Barre syndrome variants and overlaps of MG with myositis and/or myocarditis also occurred. One quarter of myasthenia patients presented with exacerbations of previously diagnosed myasthenia gravis, while neuropathy and myopathy typically presented with a new onset. Most patients improved with immunomodulatory treatment, but neuromuscular complications were sometimes refractory and associated with high mortality of 26% from cancer recurrence, comorbidities, or treatment complications. Poor outcomes were more common with exacerbations of pre-existing myasthenia gravis and myocarditis overlap. Future prospective studies are needed to elucidate mechanisms and risk factors for autoimmune adverse events following immune checkpoint blockade.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Debilidade Muscular/induzido quimicamente , Miastenia Gravis/induzido quimicamente , Miosite/induzido quimicamente , Neoplasias/tratamento farmacológico , Humanos
15.
Int J Clin Pharm ; 41(1): 251-257, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30499028

RESUMO

Background Polypharmacy is a growing health concern for older adults and is associated with poorer clinical outcome. Objective This study aim is to investigate the association between polypharmacy and impairment in cognitive, physical and emotional capability controlling for the confounding effect of co-morbidities. Setting The Aberdeen 1936 Birth Cohort from 1999 to 2004. Method Recruited were 498 dementia free participants around 64 years old and recruited into wave one. Linear regression and structural equation models were used. Models were adjusted for the effect of age, gender, childhood IQ, education and Body Mass Index. A triad of impairment was defined as a composite measure of impairment in cognitive, physical and emotional function. Main outcome measure The relationships between polypharmacy, co-morbidity and triad of impairment. Results The prevalence of polypharmacy was 12.3% in this relatively healthy sample. Polypharmacy was significantly associated with increased impairment in cognitive, physical and emotional ability (ß = 3.6, p = 0.003) after controlling for the effect of comorbidities and other confounding variables. As expected, higher childhood IQ and educational achievement had protective effects against impairment while higher comorbidity score and Body Mass Index were associated with increased impairment in this population. Conclusions The independent association of polypharmacy and reduced cognitive, physical and emotional capability makes this a promising target for predicting and potentially reducing the risk of impairment and associated healthcare costs in older adults. Longitudinal studies are required to investigate the underlying mechanisms for the observed relationships further.


Assuntos
Sintomas Afetivos/induzido quimicamente , Disfunção Cognitiva/induzido quimicamente , Inquéritos Epidemiológicos/métodos , Testes Neuropsicológicos , Polimedicação , Sintomas Afetivos/diagnóstico , Sintomas Afetivos/epidemiologia , Fatores Etários , Idoso , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/induzido quimicamente , Debilidade Muscular/diagnóstico , Debilidade Muscular/epidemiologia , Dor/induzido quimicamente , Dor/diagnóstico , Dor/epidemiologia , Fatores de Risco
17.
Muscle Nerve ; 59(5): 537-543, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30549046

RESUMO

INTRODUCTION: Statins reduce cardiovascular disease risk and are generally well tolerated, yet up to 0.5% of statin-treated patients develop incapacitating muscle symptoms including rhabdomyolysis. Our objective was to identify clinical factors related to statin-associated muscle symptoms (SAMS). METHODS: Clinical and laboratory characteristics were evaluated in 748 statin-treated Caucasians (634 with SAMS and 114 statin-tolerant controls). Information was collected on statin type, concomitant drug therapies, muscle symptom history, comorbidities, and family history. Logistic regression was used to identify associations. RESULTS: Individuals with SAMS were 3.6 times (odds ratio [OR] 3.60, 95% confidence interval [CI] 2.08-6.22) more likely than statin-tolerant controls to have a family history of heart disease. Additional associations included obesity (OR 3.08, 95% CI 1.18, 8.05), hypertension (OR 2.24, 95% CI 1.33, 3.77), smoking (OR 2.08, 95% CI 1.16, 3.74), and statin type. DISCUSSION: Careful medical monitoring of statin-treated patients with the associated coexisting conditions may ultimately reduce muscle symptoms and lead to improved compliance. Muscle Nerve 59:537-537, 2019.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Debilidade Muscular/induzido quimicamente , Mialgia/induzido quimicamente , Rabdomiólise/induzido quimicamente , Idoso , Atorvastatina/efeitos adversos , Grupo com Ancestrais do Continente Europeu , Feminino , Cardiopatias , Humanos , Hipertensão/epidemiologia , Modelos Logísticos , Lovastatina/efeitos adversos , Masculino , Anamnese , Pessoa de Meia-Idade , Debilidade Muscular/epidemiologia , Doenças Musculares/induzido quimicamente , Doenças Musculares/epidemiologia , Mialgia/epidemiologia , Obesidade/epidemiologia , Razão de Chances , Pravastatina/efeitos adversos , Estudos Retrospectivos , Rabdomiólise/epidemiologia , Fatores de Risco , Rosuvastatina Cálcica/efeitos adversos , Sinvastatina/efeitos adversos , Fumar/epidemiologia
18.
Chest ; 154(4): 781-787, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30217640

RESUMO

BACKGROUND: Vasoactive medications are commonly used in the treatment of critically ill patients, but their impact on the development of ICU-acquired weakness is not well described. The objective of this study is to evaluate the relationship between vasoactive medication use and the outcome of ICU-acquired weakness. METHODS: This is a secondary analysis of mechanically ventilated patients (N = 172) enrolled in a randomized clinical trial of early occupational and physical therapy vs conventional therapy, which evaluated the end point of ICU-acquired weakness on hospital discharge. Patients underwent bedside muscle strength testing by a therapist blinded to study allocation to evaluate for ICU-acquired weakness. The effects of vasoactive medication use on the incidence of ICU-acquired weakness in this population were assessed. RESULTS: On logistic regression analysis, the use of vasoactive medications increased the odds of developing ICU-acquired weakness (odds ratio [OR], 3.2; P = .01) independent of all other established risk factors for weakness. Duration of vasoactive medication use (in days) (OR, 1.35; P = .004) and cumulative norepinephrine dose (µg/kg/d) (OR, 1.01; P = .02) (but not vasopressin or phenylephrine) were also independently associated with the outcome of ICU-acquired weakness. CONCLUSIONS: In mechanically ventilated patients enrolled in a randomized clinical trial of early mobilization, the use of vasoactive medications was independently associated with the development of ICU-acquired weakness. Prospective trials to further evaluate this relationship are merited. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01777035; URL: www.clinicaltrials.gov.


Assuntos
Deambulação Precoce/efeitos adversos , Debilidade Muscular/induzido quimicamente , Respiração Artificial/efeitos adversos , Vasoconstritores/efeitos adversos , Idoso , Cuidados Críticos/métodos , Feminino , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Força Muscular/efeitos dos fármacos , Terapia Ocupacional/métodos , Modalidades de Fisioterapia
19.
Ned Tijdschr Geneeskd ; 1622018 08 16.
Artigo em Holandês | MEDLINE | ID: mdl-30212012

RESUMO

BACKGROUND: Valproic acid is one of the most widely prescribed drugs for the treatment of epilepsy and bipolar disorder. As only the unbound fraction of a medicinal product is pharmacologically active, in some strong protein-bound psychotropic drugs such as valproic acid and phenytoin, a rise in this fraction can lead to severe toxicity. CASE DESCRIPTION: A 65-year-old male with a type 1 bipolar disorder developed a number of neurological symptoms including sluggishness, muscle weakness, difficulty in walking and disorders of micturition after his mood stabiliser was changed to valproic acid. Recognition of drug toxicity was delayed as his total plasma valproic acid levels were within the therapeutic range. Later it became apparent that the patient had toxic unbound valproic acid levels due to hypoalbuminaemia and impaired renal function. CONCLUSION: Clinicians should always consider drug toxicity in patients who show neurological symptoms and use highly protein-bound psychotropic drugs, even if the total plasma concentration of the drug is in the therapeutic range.


Assuntos
Anticonvulsivantes/efeitos adversos , Transtorno Bipolar/tratamento farmacológico , Hipoalbuminemia/sangue , Doenças do Sistema Nervoso/induzido quimicamente , Ácido Valproico/efeitos adversos , Idoso , Anticonvulsivantes/sangue , Transtorno Bipolar/sangue , Transtorno Bipolar/complicações , Humanos , Hipoalbuminemia/complicações , Masculino , Limitação da Mobilidade , Debilidade Muscular/induzido quimicamente , Transtornos Urinários/induzido quimicamente , Ácido Valproico/sangue
20.
Anaesthesia ; 73(9): 1079-1089, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30132821

RESUMO

Neostigmine reverses non-depolarising neuromuscular blockade, but may cause muscle weakness when administered after full recovery of neuromuscular function. We hypothesised that neostigmine in therapeutic doses impairs muscle strength and respiratory function in awake healthy volunteers. Twenty-one volunteers were randomised to receive two doses of either intravenous (i.v.) neostigmine 2.5 mg with glycopyrrolate 450 µg (neostigmine group, n = 14) or normal saline 0.9% (placebo group, n = 7). The first dose was administered immediately after obtaining baseline measurements, and the second dose was administered 15 min later. All 14 volunteers in the neostigmine group received the first dose, mean (SD) 35 (5.8) µg.kg-1 , but only nine of these volunteers agreed to receive the second dose, 34 (3.5) ?g.kg-1 . The primary outcome was hand grip strength. Secondary outcomes were train-of-four ratio, single twitch height, forced expiratory volume in 1 s, forced vital capacity, forced expiratory volume in 1 s/forced vital capacity ratio, oxygen saturation, heart rate and mean arterial pressure. The first dose of intravenous neostigmine with glycopyrrolate resulted in reduced grip strength compared with placebo, -20 (20) % vs. +4.3 (9.9) %, p = 0.0016; depolarising neuromuscular blockade with decreased single twitch height, -14 (11) % vs. -3.8 (5.6) %, p = 0.0077; a restrictive spirometry pattern with decreased predicted forced expiratory volume in 1 s, -15 (12) % vs. -0.47 (3.4) %, p = 0.0011; and predicted forced vital capacity, -20 (12) % vs. -0.59 (3.2) %, p < 0.0001 at 5 min after administration. The second dose of neostigmine with glycopyrrolate further decreased grip strength mean (SD) -41 (23) % vs. +1.0 (15) %, p = 0.0004; single twitch height -25 (15) % vs. -2.5 (6.6) %, p = 0.0030; predicted forced expiratory volume in 1 s -23 (24) % vs. -0.7 (4.4) %, p = 0.0063; and predicted forced vital capacity, -27.1 (22.0) % vs. -0.66 (3.9) %, p = 0.0010. Train-of-four ratio remained unchanged (p = 0.22). In healthy volunteers, therapeutic doses of neostigmine induced significant and dose-dependent muscle weakness, demonstrated by a decrease in maximum voluntary hand grip strength and a restrictive spirometry pattern secondary to depolarising neuromuscular blockade.


Assuntos
Inibidores da Colinesterase/administração & dosagem , Debilidade Muscular/induzido quimicamente , Neostigmina/administração & dosagem , Bloqueio Neuromuscular/métodos , Adulto , Inibidores da Colinesterase/efeitos adversos , Relação Dose-Resposta a Droga , Método Duplo-Cego , Esquema de Medicação , Feminino , Volume Expiratório Forçado/efeitos dos fármacos , Força da Mão , Humanos , Injeções Intravenosas , Masculino , Neostigmina/efeitos adversos , Junção Neuromuscular/efeitos dos fármacos , Fármacos Neuromusculares não Despolarizantes/antagonistas & inibidores , Capacidade Vital/efeitos dos fármacos , Vigília , Adulto Jovem
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