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1.
Am J Case Rep ; 20: 1949-1955, 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31879415

RESUMO

BACKGROUND Trazodone is widely used in the treatment of depression, anxiety, and insomnia. It is thought to have a safe cardiac profile due to the relative lack of anticholinergic effects. Publications about cardiac toxicities of trazodone are scant. CASE REPORT A 55-year-old woman presented with acute disorder of consciousness secondary to an intentional trazodone overdose. She was found to have seizure activity without cerebral edema. The initial electrocardiogram was unremarkable, with a normal QTc interval. She eventually developed QTc prolongation that evolved into ventricular tachycardia, and then into a transient right bundle-branch block, left anterior fascicular block, and variable degrees of atrioventricular nodal blocks at 12-24 h after ingestion. She then developed generalized tonic-clonic seizures, cardiogenic shock, and respiratory arrest. She was intubated and treated with antiepileptics, norepinephrine, and dopamine infusion. QTc interval prolongation gradually resolved and the various forms of heart block did not recur after at 24-36 h. She did not require transcutaneous pacing, and was successfully extubated with intact neurological function. CONCLUSIONS Fatal arrhythmias can occur in trazodone overdose. Close monitoring and supportive care are crucial for patient survival.


Assuntos
Ansiolíticos/efeitos adversos , Bloqueio de Ramo/induzido quimicamente , Overdose de Drogas/complicações , Síndrome do QT Longo/induzido quimicamente , Convulsões/induzido quimicamente , Taquicardia Ventricular/induzido quimicamente , Trazodona/efeitos adversos , Anticonvulsivantes/uso terapêutico , Bloqueio de Ramo/diagnóstico por imagem , Bloqueio de Ramo/tratamento farmacológico , Dopamina/uso terapêutico , Eletrocardiografia , Feminino , Humanos , Síndrome do QT Longo/diagnóstico por imagem , Síndrome do QT Longo/tratamento farmacológico , Pessoa de Meia-Idade , Norepinefrina/uso terapêutico , Taquicardia Ventricular/diagnóstico por imagem , Taquicardia Ventricular/tratamento farmacológico
3.
Int J Dev Neurosci ; 78: 7-18, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31369794

RESUMO

Perinatal hypoxia-ischemia is one of the most common causes of perinatal brain injury and subsequent neurological disorders in children. The aim of this work was to evaluate the potential antioxidant and neuroprotective effects of N-arachidonoyl-dopamine (NADA) in the model of acute neonatal hypoxia (ANH) in rat pups. Male and female Wistar rats were exposed to a hypoxic condition (8% oxygen for 120 min) at postnatal day 2 (P2). Transcription factor HIF1-α and glutathione peroxidases GPx2 and GPx4 gene expression was increased in rat brains in the hypoxic group compared to control 1.5 h but not 4 days after ANH. There were no post-hypoxic changes in reduced (GSH) and oxidised (GSSG) glutathione levels in the brain of rat pups 1.5 h and 4 d after hypoxia. Hypoxic rats displayed retarded performance in the righting reflex and the negative geotaxis tests. ANH resulted in increased ambulation in Open field test and impaired retention in the Barnes maze task under stressful conditions as compared with the control group. Treatment with NADA significantly attenuated the delayed development of sensorimotor reflexes and stress-evoked disruption of memory retention in hypoxic rats but had no effect on the hypoxia-induced hyperactivity. In rats exposed to hypoxia, treatment with NADA decreased GPx2 gene expression and increased GSH/GSSG ratio in whole brains 1.5 h after ANH. These results suggest that the long-lasting beneficial effects of NADA on hypoxia-induced neurobehavioural deficits are mediated, at least in part, by its antioxidant properties.


Assuntos
Antioxidantes/metabolismo , Ácidos Araquidônicos/farmacologia , Encéfalo/efeitos dos fármacos , Dopamina/análogos & derivados , Hipóxia-Isquemia Encefálica/tratamento farmacológico , Fármacos Neuroprotetores/farmacologia , Animais , Ácidos Araquidônicos/uso terapêutico , Encéfalo/metabolismo , Dopamina/farmacologia , Dopamina/uso terapêutico , Feminino , Glutationa/metabolismo , Glutationa Peroxidase/metabolismo , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Hipóxia-Isquemia Encefálica/metabolismo , Masculino , Aprendizagem em Labirinto/efeitos dos fármacos , Atividade Motora/efeitos dos fármacos , Fármacos Neuroprotetores/uso terapêutico , Ratos , Ratos Wistar , Reflexo de Endireitamento/efeitos dos fármacos
4.
Brain Nerve ; 71(8): 857-867, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31346142

RESUMO

Over the last few decades, several delayed-start trials have suggested that early introduction of dopamine replacement therapy can improve the prognosis of Parkinson's disease (PD). Moreover, several observations support that L-dopa is non toxic to normal and diseased substantia nigra in humans. Thus, the clinical practice guideline 2018 for PD recommends L-dopa as an initial treatment for PD, in principle. More recently, several potential disease-modifying therapies have been reported to be effective. Furthermore, several recent studies suggest that exercise can be beneficial in delaying disease progression.


Assuntos
Levodopa/uso terapêutico , Doença de Parkinson/tratamento farmacológico , Guias de Prática Clínica como Assunto , Progressão da Doença , Dopamina/uso terapêutico , Exercício Físico , Humanos , Doença de Parkinson/terapia , Substância Negra/fisiopatologia
6.
J Pediatr ; 211: 13-19.e3, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31155392

RESUMO

OBJECTIVE: To investigate whether hydrocortisone supplementation increases blood pressure and decreases inotrope requirements compared with placebo in cooled, asphyxiated neonates with volume-resistant hypotension. STUDY DESIGN: A double-blind, randomized, placebo-controlled clinical trial was conducted in a Level III neonatal intensive care unit in 2016-2017. Thirty-five asphyxiated neonates with volume-resistant hypotension (defined as a mean arterial pressure [MAP] < gestational age in weeks) were randomly assigned to receive 0.5 mg/kg/6 hours of hydrocortisone or placebo in addition to standard dopamine treatment during hypothermia. RESULTS: More patients reached the target of at least 5-mm Hg increment of MAP in 2 hours after randomization in the hydrocortisone group, compared with the placebo group (94% vs 58%, P = .02, intention-to-treat analysis). The duration of cardiovascular support (P = .001) as well as cumulative (P < .001) and peak inotrope dosage (P < .001) were lower in the hydrocortisone group. In a per-protocol analysis, regression modeling predicted that a 4-mm Hg increase in MAP in response to hydrocortisone treatment was comparable with the effect of 15 µg/kg/min of dopamine in this patient population. Serum cortisol concentrations were low before randomization in both the hydrocortisone and placebo groups (median 3.5 and 3.3 µg/dL, P = .87; respectively), suggesting inappropriate adrenal function. Short-term clinical outcomes were similar in the 2 groups. CONCLUSIONS: Hydrocortisone administration was effective in raising the blood pressure and decreasing inotrope requirement in asphyxiated neonates with volume-resistant hypotension during hypothermia treatment. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02700828.


Assuntos
Asfixia Neonatal/terapia , Dopamina/uso terapêutico , Hidrocortisona/administração & dosagem , Hidrocortisona/sangue , Hipotensão/terapia , Hipotermia Induzida , Hipóxia-Isquemia Encefálica/tratamento farmacológico , Pressão Sanguínea , Método Duplo-Cego , Feminino , Idade Gestacional , Humanos , Hipotermia , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal , Masculino , Análise de Regressão
7.
Crit Care ; 23(1): 168, 2019 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088524

RESUMO

BACKGROUND: Catecholamines, especially norepinephrine, are the most frequently used vasopressors for treating patients with septic shock. During the recent decades, terlipressin, vasopressin V1A agonist, and even Ca2+ sensitizer were increasingly used by physicians. The aim of this study is to compare the efficacy of such different kinds of vasoactive medications on mortality among patients with septic shock. METHODS: Relevant randomized controlled trials were identified by searching PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials updated to February 22, 2018. A network meta-analysis was performed to evaluate the effect of different types of vasoactive medications. The primary outcome was 28-day mortality. Intensive care unit (ICU) mortality, hospital and ICU length of stay (LOS), and adverse events were also assessed. RESULTS: A total of 43 trials with 5767 patients assessing 17 treatment modalities were included. Treatments ranking based on surface under the cumulative ranking curve values from largest to smallest were NE/DB 85.9%, TP 75.1%, NE/EP 74.6%, PI 74.1%, EP 72.5%, VP 66.1%, NE 59.8%, PE 53.0%, DA 42.1%, DX 38.2%, SP 27.0%, PA 24.3%, EX 22.8%, LE 21.5%, and DB 13.3% for 28-day mortality. Treatments ranking for ICU mortality were TP/NE 86.4%, TP 80.3%, TP/DB/NE 65.7%, VP/NE 62.8%, NE 57.4%, VP 56.5%, PE 48.4%, DA 33.0%, PA 27.5%, LE 22.1%, and DB 9.9%. The incidence of myocardial infarction was reported with NE/EP 3.33% (n = 1 of 30), followed by EP 3.11% (n = 5 of 161), and then VP 3.10% (n = 19 of 613), NE 3.03% (n = 43 of 1417), DA 2.21% (n = 19 of 858), NE/DB 2.01% (n = 4 of 199), LE 1.16% (n = 3 of 258), and PA 0.39% (n = 1 of 257). The incidence of arrhythmia was reported with DA 26.01% (n = 258 of 992), followed by EP 22.98% (n = 37 of 161), and then NE/DB 20.60% (n = 41 of 199), NE/EP 20.0% (n = 6 of 30), NE 8.33% (n = 127 of 1525), LE 5.81% (n = 15 of 258), PA 2.33% (n = 6 of 257), and VP 1.67% (n = 10 of 600). CONCLUSIONS: The use of norepinephrine plus dobutamine was associated with lower 28-day mortality for septic shock, especially among patients with lower cardiac output.


Assuntos
Catecolaminas/normas , Choque Séptico/tratamento farmacológico , Catecolaminas/uso terapêutico , Dopamina/normas , Dopamina/uso terapêutico , Humanos , Mortalidade/tendências , Norepinefrina/normas , Norepinefrina/uso terapêutico , Razão de Chances , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Terlipressina/normas , Terlipressina/uso terapêutico , Vasopressinas/normas , Vasopressinas/uso terapêutico
8.
J Med Case Rep ; 13(1): 104, 2019 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-31014402

RESUMO

BACKGROUND: There are reports of the familial occurrence of Kawasaki disease but only a few reports described Kawasaki disease in siblings. However, the familial cases were not simultaneous. In these patients the idea of infective agents as trigger must be considered. CASE PRESENTATION: We describe two siblings with atypical presentations of Kawasaki disease; the sister was first diagnosed as having parvovirus infection with anemia and the brother was diagnosed as having myocarditis. The first patient was a 9-month-old Caucasian girl with fever, conjunctivitis, rash, and pharyngitis, and later she had cervical adenopathy, diarrhea and vomiting, leukocytosis, and anemia, which were explained by positive immunoglobulin M against parvovirus. However, coronary artery lesions with aneurysms were documented at day 26 after fever onset. An infusion of intravenous immunoglobulin and high doses of steroids were not efficacious to resolve the coronary lesions. She was treated with anakinra, despite a laboratory test not showing inflammation, with prompt and progressive improvement of coronary lesions. Her 7-year-old Caucasian brother presented vomiting and fever at the same time as she was unwell, which spontaneously resolved after 4 days. Four days later, he again presented with fever with abdominal pain, associated with tachypnea, stasis at the pulmonary bases, tachycardia, gallop rhythm, hypotension, secondary anuria, and hepatomegaly. An echocardiogram revealed a severe hypokinesia, with a severe reduction of the ejection fraction (20%). He had an increase of immunoglobulin M anti-parvovirus, tested for the index case of his sister, confirming the suspicion of viral myocarditis. He received dopamine, dobutamine, furosemide plus steroids, with a progressive increase of the ejection fraction to 50%. However, evaluating his sister's history, the brother showed a myocardial dysfunction secondary to Kawasaki shock syndrome. CONCLUSIONS: We report on familial Kawasaki disease in two siblings which had the same infectious trigger (a documented parvovirus infection). The brother was diagnosed as having post-viral myocarditis. However, in view of the two different and simultaneous evolutions, the girl showed Kawasaki disease with late coronary artery lesions and aneurysms, whereas the brother showed Kawasaki shock syndrome with myocardial dysfunction. We stress the effectiveness of anakinra in non-responder Kawasaki disease and the efficacy on coronary aneurysms.


Assuntos
Aneurisma Coronário/virologia , Fatores Imunológicos/uso terapêutico , Infecções por Parvoviridae/complicações , Parvovirus/isolamento & purificação , Choque/virologia , Irmãos , Cardiotônicos/uso terapêutico , Criança , Aneurisma Coronário/tratamento farmacológico , Aneurisma Coronário/fisiopatologia , Dobutamina/uso terapêutico , Dopamina/uso terapêutico , Ecocardiografia , Feminino , Humanos , Imunossupressores/uso terapêutico , Lactente , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Masculino , Infecções por Parvoviridae/tratamento farmacológico , Infecções por Parvoviridae/fisiopatologia , Choque/fisiopatologia , Volume Sistólico , Resultado do Tratamento
9.
Clin Perinatol ; 46(2): 273-290, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31010560

RESUMO

There is a distinct lack of age-appropriate cardiotonic drugs, and adult derived formulations continue to be administered, without evidence-based knowledge on their dosing, safety, efficacy, and long-term effects. Dopamine remains the most commonly studied and prescribed cardiotonic drug in the neonatal intensive care unit (NICU), but evidence of its effect on endorgan perfusion still remains. Unlike adult and pediatric critical care, there are significant gaps in our knowledge on the use of various cardiotonic drugs in various forms of circulatory failure in the NICU.


Assuntos
Cardiotônicos/uso terapêutico , Hipotensão/tratamento farmacológico , Choque/tratamento farmacológico , Vasoconstritores/uso terapêutico , Corticosteroides/uso terapêutico , Asfixia Neonatal/complicações , Dobutamina/uso terapêutico , Dopamina/uso terapêutico , Cardiopatias Congênitas/complicações , Humanos , Hipotensão/etiologia , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Milrinona/uso terapêutico , Sepse Neonatal/complicações , Norepinefrina/uso terapêutico , Síndrome da Persistência do Padrão de Circulação Fetal/complicações , Choque/etiologia , Simendana/uso terapêutico , Vasopressinas/uso terapêutico
10.
Anesthesiology ; 130(4): 592-608, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30676422

RESUMO

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Chronic alcohol use and withdrawal leads to increased pain perception, anxiety, and depression. These aberrant behaviors are accompanied by increased excitatory glutamatergic transmission to, and activity of, the lateral habenula neurons.Vanilloid type 1, or TRPV1, channels are expressed in the habenula and they facilitate glutamatergic transmission. Whether TRPV1 channel plays a role in habenula hyperactivity is not clear. WHAT THIS ARTICLE TELLS US THAT IS NEW: Glutamatergic transmission in the lateral habenula was inhibited by TRPV1 channel antagonists. In vivo, local administration of TRPV1 antagonists into the lateral habenula attenuated hyperalgesia, anxiety, and relapse-like drinking in rats who chronically consumed alcohol.The data suggest that enhanced TRPV1 channel function during withdrawal may contribute to aberrant behavior that promotes relapse alcohol consumption. BACKGROUND: Recent rat studies indicate that alcohol withdrawal can trigger a negative emotional state including anxiety- and depression-like behaviors and hyperalgesia, as well as elevated glutamatergic transmission and activity in lateral habenula neurons. TRPV1, a vanilloid receptor expressed in the habenula, is involved in pain, alcohol dependence, and glutamatergic transmission. The authors therefore hypothesized that TRPV1 contributes to the changes in both the behavioral phenotypes and the habenula activity in alcohol-withdrawn rats. METHODS: Adult male Long-Evans rats (n = 110 and 280 for electrophysiology and behaviors, respectively), randomly assigned into the alcohol and water (Naïve) groups, were trained to consume either alcohol or water-only using an intermittent-access procedure. Slice electrophysiology was used to measure spontaneous excitatory postsynaptic currents and firing of lateral habenula neurons. The primary outcome was the change in alcohol-related behaviors and lateral habenula activity induced by pharmacologic manipulation of TRPV1 activity. RESULTS: The basal frequency of spontaneous excitatory postsynaptic currents and firing of lateral habenula neurons in alcohol-withdrawn rats was significantly increased. The TRPV1 antagonist capsazepine (10 µM) induced a stronger inhibition on spontaneous excitatory postsynaptic currents (mean ± SD; by 26.1 ± 27.9% [n = 11] vs. 6.7 ± 18.6% [n = 17], P = 0.027) and firing (by 23.4 ± 17.6% [n = 9] vs. 11.9 ± 16.3% [n = 12], P = 0.025) in Withdrawn rats than Naive rats. By contrast, the TRPV1 agonist capsaicin (3 µM) produced a weaker potentiation in Withdrawn than Naïve rats (spontaneous excitatory postsynaptic currents: by 203.6 ± 124.7% [n = 20] vs. 415.2 ± 424.3% [n = 15], P < 0.001; firing: 38.1 ± 14.7% [n = 11] vs. 73.9 ± 41.9% [n = 11], P < 0.001). Conversely, capsaicin's actions in Naïve but not in Withdrawn rats were significantly attenuated by the pretreatment of TRPV1 endogenous agonist N-Oleoyldopamine. In Withdrawn rats, intra-habenula infusion of TRPV1 antagonists attenuated hyperalgesia and anxiety-like behaviors, decreased alcohol consumption upon resuming drinking, and elicited a conditioned place preference. CONCLUSIONS: Enhanced TRPV1 function may contribute to increased glutamatergic transmission and activity of lateral habenula neurons, resulting in the aberrant behaviors during ethanol withdrawal.


Assuntos
Alcoolismo/metabolismo , Aprendizagem da Esquiva/fisiologia , Habenula/metabolismo , Síndrome de Abstinência a Substâncias/metabolismo , Canais de Cátion TRPV/biossíntese , Alcoolismo/complicações , Alcoolismo/tratamento farmacológico , Animais , Aprendizagem da Esquiva/efeitos dos fármacos , Dopamina/análogos & derivados , Dopamina/farmacologia , Dopamina/uso terapêutico , Etanol/administração & dosagem , Habenula/efeitos dos fármacos , Masculino , Técnicas de Cultura de Órgãos , Ratos , Ratos Long-Evans , Síndrome de Abstinência a Substâncias/tratamento farmacológico , Síndrome de Abstinência a Substâncias/etiologia , Canais de Cátion TRPV/antagonistas & inibidores
11.
Neuropediatrics ; 50(1): 2-14, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30372766

RESUMO

Neurotransmitter deficiencies are rare neurological disorders with clinical onset during childhood. The disorders are caused by genetic defects in the enzymes involved in synthesis, degradation, or transport of neurotransmitters or by defects in the cofactor biosynthesis such as tetrahydrobiopterin (BH4). With the newly described DNAJC12 deficiency, a chaperon-associated neurotransmitter disorder, the pathophysiological spectrum has been broadened. All deficiencies result in a lack of monoamine neurotransmitters, especially dopamine and its products, with a subset leading to decreased levels of serotonin. Symptoms can occur already in the neonatal period. Classical signs are hypotonia, movement disorders, autonomous dysregulations, and impaired development. Diagnosis depends on quantitative detection of neurotransmitters in cerebrospinal fluid, since peripheral markers in blood or urine are less reliable. Treatment is based on supplementation of the missing neurotransmitter precursors or restoring deficient cofactors for endogenous enzymatic synthesis. In recent years, knowledge about this orphan group of diseases increased substantially among clinicians. However, the difficult task of integrating clinical symptoms and laboratory values still leads to a critical delay in diagnosis and therapy for patients. This review aims at enhancing the understanding of neurotransmitter disorders and should help practicing clinicians to choose useful diagnostic steps on the way to a valid diagnosis.


Assuntos
Transtornos dos Movimentos/diagnóstico , Transtornos dos Movimentos/metabolismo , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/metabolismo , Neurotransmissores/deficiência , Animais , Dopamina/deficiência , Dopamina/uso terapêutico , Humanos , Transtornos dos Movimentos/tratamento farmacológico , Doenças do Sistema Nervoso/tratamento farmacológico , Neurotransmissores/uso terapêutico , Serotonina/deficiência , Serotonina/uso terapêutico
12.
Asian Cardiovasc Thorac Ann ; 27(1): 30-32, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29933705

RESUMO

Methamphetamine and its related compounds are among the most widely abused recreational drugs worldwide. While a myriad of clinical complications of methamphetamine use have been described, there is a paucity of literature regarding the effects of maternal abuse during pregnancy on neonatal hearts. In this report, we describe a neonate who underwent Norwood-type palliation and subsequently developed catecholamine-resistant cardiogenic shock, likely related to methamphetamine exposure, which recovered after a period of venoarterial extracorporeal membrane oxygenation support.


Assuntos
Transtornos Relacionados ao Uso de Anfetaminas/complicações , Cardiotônicos/uso terapêutico , Estimulantes do Sistema Nervoso Central/efeitos adversos , Dopamina/uso terapêutico , Resistência a Medicamentos , Oxigenação por Membrana Extracorpórea , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Metanfetamina/efeitos adversos , Milrinona/uso terapêutico , Procedimentos de Norwood/efeitos adversos , Choque Cardiogênico/terapia , Feminino , Humanos , Síndrome do Coração Esquerdo Hipoplásico/complicações , Síndrome do Coração Esquerdo Hipoplásico/diagnóstico , Síndrome do Coração Esquerdo Hipoplásico/fisiopatologia , Recém-Nascido , Masculino , Exposição Materna/efeitos adversos , Gravidez , Fatores de Risco , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/etiologia , Choque Cardiogênico/fisiopatologia , Resultado do Tratamento
13.
Acta Anaesthesiol Scand ; 63(4): 424-437, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30515766

RESUMO

BACKGROUND: Dopamine has been used in patients with cardiac dysfunction for more than five decades. Yet, no systematic review has assessed the effects of dopamine in critically ill patients with cardiac dysfunction. METHODS: This systematic review was conducted following The Cochrane Handbook for Systematic Reviews of Interventions. We searched for trials including patients with observed cardiac dysfunction published until 19 April 2018. Risk of bias was evaluated and Trial Sequential Analyses were conducted. The primary outcome was all-cause mortality at longest follow-up. Secondary outcomes were serious adverse events, myocardial infarction, arrhythmias, and renal replacement therapy. We used GRADE to assess the certainty of the evidence. RESULTS: We identified 17 trials randomising 1218 participants. All trials were at high risk of bias and only one trial used placebo. Dopamine compared with any control treatment was not significantly associated with relative risk of mortality (60/457 [13%] vs 90/581 [15%]; RR 0.91; 95% confidence interval 0.68-1.21) or any other patient-centred outcomes. Trial Sequential Analyses of all outcomes showed that there was insufficient information to confirm or reject our anticipated intervention effects. There were also no statistically significant associations for any of the outcomes in subgroup analyses by type of comparator (inactive compared to potentially active), dopamine dose (low compared to moderate dose), or setting (cardiac surgery compared to heart failure). CONCLUSION: Evidence for dopamine in critically ill patients with cardiac dysfunction is sparse, of low quality, and inconclusive. The use of dopamine for cardiac dysfunction can neither be recommended nor refuted.


Assuntos
Cardiotônicos/uso terapêutico , Estado Terminal/terapia , Dopamina/uso terapêutico , Cardiopatias/tratamento farmacológico , Ensaios Clínicos como Assunto , Humanos
15.
Medicine (Baltimore) ; 97(45): e13129, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30407335

RESUMO

RATIONALE: Lithium has been used to treat bipolar disorder. Lithium has a narrow therapeutic index, with a therapeutic level between 0.6 and 1.5 mEq/L. The possible complications of lithium overdose include altered mental status, hand tremor, muscle weakness, nausea, vomiting, diarrhea, seizure, syncope, and arrhythmia. Lithium intoxication can be fatal and is difficult to diagnose in patients without a history of lithium intake. The occurrence of serious cardiac arrhythmias is rare in lithium intoxication. PATIENT CONCERNS: An 81-year-old man was brought to the emergency department because of consciousness disturbance for 2 days. According to his daughter, he had a history of hypertension and diabetes. Recently, his family also observed slurring of speech and easy choking. The physical examination findings were unremarkable. DIAGNOSIS: Blood examination only revealed impaired renal function. Twelve-lead electrocardiography revealed sinus rhythm with first-degree atrioventricular block. Chest radiography revealed mediastinal widening. The blood pressures obtained from the 4 limbs showed no significant differences. Subsequently, brain computed tomography revealed no obvious intracranial lesion. A neurologist was consulted, and a recent ischemic stroke could not be ruled out. While in the observation area, his systolic blood pressure decreased to <90 mm Hg and he showed bradycardia, and 12-lead electrocardiography revealed an AV block and long pulse. Contrast-enhanced chest computed tomography revealed no evidence of aortic dissection. Another family member reported a history of lithium intake for bipolar disorder for >30 years. Blood examination revealed a lithium concentration of 2.65 mEq/L. INTERVENTIONS: A nephrologist was consulted, and emergency hemodialysis was indicated. Dopamine was administered for his shock status via a right neck central venous catheter. OUTCOMES: His lithium level gradually declined after the hemodialysis, and blood pressure and consciousness level improved subsequently. The patient was discharged 9 days later in a stable condition. LESSONS: If an emergency physician encounters a patient with altered consciousness and arrhythmia with cardiogenic shock, the patient's drug intake history should be carefully reviewed to rule out cardiovascular problems on the basis of the patient's clinical condition.


Assuntos
Antidepressivos/envenenamento , Overdose de Drogas/diagnóstico , Compostos de Lítio/envenenamento , Idoso de 80 Anos ou mais , Antidepressivos/sangue , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/terapia , Cardiotônicos/uso terapêutico , Transtornos da Consciência/etiologia , Dopamina/uso terapêutico , Overdose de Drogas/terapia , Eletrocardiografia , Humanos , Compostos de Lítio/sangue , Masculino , Diálise Renal/métodos , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia
16.
J Korean Med Sci ; 33(47): e300, 2018 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-30450025

RESUMO

Parkinson's disease (PD) is the second most common neurodegenerative disorder. Although its major manifestation is motor symptoms, resulting from the loss of dopaminergic neurons in the substantia nigra, psychiatric symptoms, such as depression, anxiety, hallucination, delusion, apathy and anhedonia, impulsive and compulsive behaviors, and cognitive dysfunction, may also manifest in most patients with PD. Given that the quality of life - and the need for institutionalization - is so highly dependent on the psychiatric well-being of patients with PD, psychiatric symptoms are of high clinical significance. We reviewed the prevalence, risk factors, pathophysiology, and treatment of psychiatric symptoms to get a better understanding of PD for improved management.


Assuntos
Ansiedade/diagnóstico , Demência/diagnóstico , Depressão/diagnóstico , Doença de Parkinson/patologia , Ansiedade/epidemiologia , Demência/epidemiologia , Depressão/tratamento farmacológico , Depressão/epidemiologia , Transtornos Disruptivos, de Controle do Impulso e da Conduta/diagnóstico , Transtornos Disruptivos, de Controle do Impulso e da Conduta/epidemiologia , Dopamina/uso terapêutico , Humanos , Doença de Parkinson/psicologia , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/epidemiologia , Antagonistas do Receptor 5-HT2 de Serotonina/uso terapêutico , Inibidores de Captação de Serotonina/uso terapêutico
17.
JACC Heart Fail ; 6(10): 859-870, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30098962

RESUMO

OBJECTIVES: This study sought to compare a continuous infusion diuretic strategy versus an intermittent bolus diuretic strategy, with the addition of low-dose dopamine (3 µg/kg/min) in the treatment of hospitalized patients with heart failure with preserved ejection fraction (HFpEF). BACKGROUND: HFpEF patients are susceptible to development of worsening renal function (WRF) when hospitalized with acute heart failure; however, inpatient treatment strategies to achieve safe and effective diuresis in HFpEF patients have not been studied to date. METHODS: In a prospective, randomized, clinical trial, 90 HFpEF patients hospitalized with acute heart failure were randomized within 24 h of admission to 1 of 4 treatments: 1) intravenous bolus furosemide administered every 12 h; 2) continuous infusion furosemide; 3) intermittent bolus furosemide with low-dose dopamine; and 4) continuous infusion furosemide with low-dose dopamine. The primary endpoint was percent change in creatinine from baseline to 72 h. Linear and logistic regression analyses with tests for interactions between diuretic and dopamine strategies were performed. RESULTS: Compared to intermittent bolus strategy, the continuous infusion strategy was associated with higher percent increase in creatinine (continuous infusion: 16.01%; 95% confidence interval [CI]: 8.58% to 23.45% vs. intermittent bolus: 4.62%; 95% CI: -1.15% to 10.39%; p = 0.02). Low-dose dopamine had no significant effect on percent change in creatinine (low-dose dopamine: 12.79%; 95% CI: 5.66% to 19.92%, vs. no-dopamine: 8.03%; 95% CI: 1.44% to 14.62%; p = 0.33). Continuous infusion was also associated with greater risk of WRF than intermittent bolus (odds ratio [OR]: 4.32; 95% CI: 1.26 to 14.74; p = 0.02); no differences in WRF risk were seen with low-dose dopamine. No significant interaction was seen between diuretic strategy and low-dose dopamine (p > 0.10). CONCLUSIONS: In HFpEF patients hospitalized with acute heart failure, low-dose dopamine had no significant impact on renal function, and a continuous infusion diuretic strategy was associated with renal impairment. (Diuretics and Dopamine in Heart Failure With Preserved Ejection Fraction [ROPA-DOP]; NCT01901809).


Assuntos
Diuréticos/administração & dosagem , Dopamina/uso terapêutico , Furosemida/administração & dosagem , Doença Aguda , Idoso , Creatinina/sangue , Diuréticos/uso terapêutico , Dopamina/administração & dosagem , Quimioterapia Combinada , Feminino , Furosemida/uso terapêutico , Insuficiência Cardíaca , Humanos , Infusões Intravenosas , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Volume Sistólico
18.
J Control Release ; 287: 156-166, 2018 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-30165139

RESUMO

Parkinson's disease (PD), one of the most common movement and neurodegenerative disorders, is challenging to treat, largely because the blood-brain barrier blocks passage of most drugs. Here we find exosomes from blood showing natural brain targeting ability which involved the transferrin-transferrin receptor interaction. Thus, we develop a biocompatible platform based on blood exosomes for delivering drugs across the blood-brain barrier. Blood exosomes show sizes between 40 and 200 nm and spherical morphology, and dopamine can be efficiently loaded into blood exosomes by a saturated solution incubation method. Further in vitro and in vivo studies demonstrates these exosomes successfully delivered dopamine to brain, including the striatum and substantia nigra. Brain distribution of dopamine increased >15-fold by using the blood exosomes as delivery system. Dopamine-loaded exosomes show much better therapeutic efficacy in a PD mouse model and lower systemic toxicity than free dopamine after intravenous administration. These results suggest that blood exosomes can be used as a promising drug delivery platform for targeted therapy against PD and other diseases of the central nervous system.


Assuntos
Encéfalo/efeitos dos fármacos , Dopaminérgicos/administração & dosagem , Dopamina/administração & dosagem , Portadores de Fármacos/metabolismo , Sistemas de Liberação de Medicamentos/métodos , Exossomos/metabolismo , Doença de Parkinson/tratamento farmacológico , Animais , Encéfalo/metabolismo , Dopamina/farmacocinética , Dopamina/uso terapêutico , Dopaminérgicos/farmacocinética , Dopaminérgicos/uso terapêutico , Camundongos , Doença de Parkinson/metabolismo
19.
J Crit Care ; 47: 333-337, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29958734

RESUMO

PURPOSE: RCTs in septic shock negative for mortality may show organ dysfunction benefits. We hypothesized that RCTs in septic shock show significant differences between treatment groups in organ support despite no mortality differences. METHODS: RCTs of epinephrine vs. norepinephrine plus dobutamine, norepinephrine vs. dopamine and vasopressin vs. norepinephrine reported days alive and free ("DAF") of vasopressors, ventilation and RRT, by subtracting days with support from the lesser of 28 or days to death. We also assigned zero DAF to non-survivors ("DAF and Mortality") and calculated the composite "DAF vasopressors, ventilation and RRT". RESULTS: Using "DAF", norepinephrine was better than dopamine for vasopressors. In contrast, using "DAF and Mortality", norepinephrine was better than dopamine for vasopressors, ventilation and RRT; norepinephrine + dobutamine was better than epinephrine for ventilation. Using the novel composite "DAF vasopressors, ventilation and RRT", norepinephrine + dobutamine was better than epinephrine (p = 0.033), norepinephrine better than dopamine (p = 0.03), and vasopressin better than norepinephrine in less severe shock (p = 0.03). CONCLUSIONS: Differences between treatment groups in organ dysfunction in RCTs in septic shock occur despite lack of mortality differences depending on calculation method. If standardized and validated further, DAF could become the primary endpoint of RCTs in septic shock.


Assuntos
Neurofisinas/metabolismo , Precursores de Proteínas/metabolismo , Choque Séptico/mortalidade , Choque/mortalidade , Vasoconstritores/uso terapêutico , Vasopressinas/metabolismo , Ensaios Clínicos como Assunto , Dobutamina/uso terapêutico , Dopamina/uso terapêutico , Epinefrina/uso terapêutico , Humanos , Norepinefrina/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Choque Séptico/tratamento farmacológico , Fatores de Tempo , Resultado do Tratamento , Vasopressinas/uso terapêutico
20.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(3)jul.-ago. 2018. ilus, tab, graf
Artigo em Português | LILACS | ID: biblio-916542

RESUMO

O sistema cardiovascular é responsável pelo fluxo circulatório adequado, o qual depende do volume sistólico e frequência cardíaca (FC). Quando insuficientes, causa hipofluxo cerebral e incapacidade de realizar atividades. A bradicardia é causada por: a) disfunção sinusal, manifestada por FC inapropriadas, pausas ou síndrome de taqui-bradicardia, síncopes, tonturas e intolerância aos esforços, sem risco à vida; b) distúrbio da condução atrioventricular (bloqueios atrioventriculares - BAV): de primeiro, segundo (Mobitz I, Mobitz II e avançado) e terceiro grau (Total) . O BAV de primeiro grau e do tipo Mobitz I tem bom prognóstico. O BAV Mobitz II, avançado e total, mesmo oligossintomático ou transitório, sem causas removíveis, tem maior morbimortalidade; c) distúrbios neuromediados e a síncope reflexa são desencadeados por posição ortostática ou exposição à estresse emocional e a síndrome do seio carotídeo associada à estimulação da carótida. A FC baixa pode estar associada a um maior risco, sendo que os sinais e sintomas indicam gravidade. Na urgência, deve-se tratar as causas subjacentes assegurar o bom funcionamento das vias aéreas administrar O2 monitorar ritmo, FC, pressão arterial, e, também, o acesso venoso. É importante analisar o ritmo, exame físico e histórico, além de pesquisar e tratar os fatores contribuintes. Caso haja sinais de baixa perfusão, deve-se administrar atropina. A estimulação por marcapasso transcutâneo é indicada, caso a atropina seja ineficaz. Além disso, deve-se considerar a adrenalina ou dopamina e estimulação transvenosa


The cardiovascular system is responsible for adequate circulatory flow, which depends on systolic volume and heart rate (HR). When insufficient, it causes cerebral hypoflow and inability to perform activities. Bradycardia is caused by: a) sinus dysfunction, manifested by inappropriate HR, pauses or tachycardia-bradycardia syndrome, syncope, dizziness and intolerance to exertion, without risk to life; b) atrioventricular conduction disorder (atrioventricular (AV) blocks): first, second (Mobitz type I, Mobitz type II and advanced) and third degree (complete). First-degree and Mobitz type I AV block both have good prognosis. Mobitz type II, advanced and complete AV block, even oligosymptomatic or transient, without removable causes, have higher morbidity and mortality; c) neuromediated disorders and reflex syncope are triggered by orthostatic position or exposure to emotional stress and carotid sinus syndrome, associated with carotid stimulation. Low HR may be associated with increased risk, and signs and symptoms indicate severity. In emergency conditions the underlying causes should be treated to ensure good functioning of the airways; administer O2; monitor cardiac rhythm, HR, blood pressure, and venous access. It is important to analyze rhythm, and conduct a physical examination and clinical history, and to check for and treat contributing factors. If there are signs of low perfusion, atropine should be administered. Simulation by transcutaneous pacemaker is indicated if atropine is ineffective. Epinephrine or dopamine and transvenous stimulation should also be considered


Assuntos
Humanos , Masculino , Feminino , Arritmias Cardíacas/terapia , Bradicardia/terapia , Emergências , Unidades de Terapia Intensiva , Perfusão/métodos , Fatores Etários , Fibrilação Atrial/complicações , Fibrilação Atrial/terapia , Bloqueio Atrioventricular/complicações , Bloqueio Atrioventricular/terapia , Atropina/administração & dosagem , Dopamina/uso terapêutico , Eletrocardiografia/métodos , Frequência Cardíaca , Hipertensão/complicações , Marca-Passo Artificial , Fatores de Risco , Síncope Vasovagal/complicações , Taquicardia Sinusal
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