Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.405
Filtrar
2.
BMJ ; 372: n251, 2021 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-33597169

RESUMO

OBJECTIVE: To describe time trends for hospital admissions due to food anaphylaxis in the United Kingdom over the past 20 years. DESIGN: Analysis of national data, 1998-2018. SETTING: Data relating to hospital admissions for anaphylaxis and deaths, and prescription data for adrenaline autoinjector devices. PARTICIPANTS: UK population as a whole and devolved nations (England, Scotland, Wales, and Northern Ireland). MAIN OUTCOME MEASURES: Time trends, age, and sex distributions for hospital admissions for anaphylaxis due to food and non-food triggers, and how these admission rates compare with the case fatality rate (number of fatalities as a proportion of hospital admissions). RESULTS: Between 1998 and 2018, 101 891 people were admitted to hospital for anaphylaxis. Of these admissions, 30 700 (30.1%) were coded as due to a food trigger. Food anaphylaxis admissions increased from 1.23 to 4.04 per 100 000 population per year (from 1998 to 2018), an annual increase of 5.7% (95% confidence interval 5.5% to 5.9%, P<0.001). The largest increase in hospital admissions was observed in children younger than 15 years, with an increase from 2.1 to 9.2 admissions per 100 000 population per year (an annual increase of 6.6%, 95% confidence interval 6.3% to 7.0%). For comparison, the annual increase was 5.9% (5.6% to 6.2%) in people aged 15-59 years and 2.1% (1.8% to 3.1%) in those aged 60 years and older. 152 deaths were identified where the fatal event was probably caused by food induced anaphylaxis. The case fatality rate decreased from 0.7% to 0.19% for confirmed fatal food anaphylaxis (rate ratio 0.931, 95% confidence interval 0.904 to 0.959, P<0.001) and to 0.30% for suspected fatal food anaphylaxis (0.970, 0.945 to 0.996, P=0.024). At least 46% (86 of 187, which also includes 35 deaths in 1992-98) of deaths were triggered by peanut or tree nut. Cow's milk was responsible for 17 of 66 (26%) deaths in school aged children. Over the same time period, prescriptions for adrenaline autoinjectors increased by 336% (estimated rate ratio 1.113, 95% confidence interval 1.112 to 1.113; an increase of 11% per year). CONCLUSIONS: Hospital admissions for food induced anaphylaxis have increased from 1998 to 2018, however the case fatality rate has decreased. In school aged children, cow's milk is now the most common single cause of fatal anaphylaxis.


Assuntos
Anafilaxia/epidemiologia , Hipersensibilidade Alimentar/epidemiologia , Hospitalização/tendências , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Anafilaxia/tratamento farmacológico , Criança , Pré-Escolar , Epinefrina/uso terapêutico , Feminino , Hipersensibilidade Alimentar/tratamento farmacológico , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Simpatomiméticos/uso terapêutico , Reino Unido/epidemiologia , Adulto Jovem
3.
Pediatr Crit Care Med ; 22(3): 286-296, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33433156

RESUMO

OBJECTIVES: Despite the evolving recommendations that favor the use of intraosseous access in pediatric resuscitation, the impact of vascular access type on survival in young children has not been demonstrated. The aim of this study was to assess the impact of the intravascular injection route on the return on spontaneous circulation, survival to hospital admission (0 day), and 30 days or survival to hospital discharge, by comparing survival rates in young children having intraosseous and peripheral IV access. The second aim was to compare the rates of favorable neurologic outcome after 30 days or survival to hospital discharge. DESIGN: This was a multicenter retrospective comparative study between July 2011 and October 2018. SETTING: Based on the French cardiac arrest registry data. PATIENTS: All prepubescent (males < 12 yr old, females < 10 yr old) victims of an out-of-hospital cardiac arrest. INTERVENTIONS: Patients with adrenaline administration by intraosseous versus peripheral venous technique were compared, using propensity score matching. MEASUREMENTS AND MAIN RESULTS: The analysis included 603 prepubescent patients, 351 (58%) in the intraosseous group and 252 (42%) in the peripheral IV group. Intraosseous group patients were younger, lighter, with more medical cause for arrest. The intraosseous group had lower survival rates at 30 days or hospital discharge (n = 6; 1.7%) than the peripheral IV group (n = 12; 4.8%) (p = 0.030). After matching, 101 pairs of patients were created. No difference was observed on return of spontaneous circulation or 0-day survival rates (odds ratio = 1.000 [95% CI, 0.518-1.930]; odds ratio = 0.946 [95% CI, 0.492-1.817], respectively) and on 30 days or hospital discharge survival (n = 3 in both groups) (odds ratio = 1.000 [95% CI, 0.197-5.076]). Meaningful statistical evaluation of neurologic status among survivors was precluded by inadequate numbers. CONCLUSIONS: The type of injection route (intraosseous or peripheral venous access) does not appear to have an impact on survival of out-of-hospital cardiac arrest in a prepubescent population, but limitations of propensity matching limit a definitive conclusion.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca Extra-Hospitalar , Criança , Pré-Escolar , Epinefrina/uso terapêutico , Feminino , Humanos , Infusões Intraósseas , Masculino , Sistema de Registros , Estudos Retrospectivos
4.
Br Dent J ; 229(11): 721-728, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33311677

RESUMO

Anaphylaxis is a severe and potentially life-threatening allergic reaction that can occur in the dental practice. There are a number of dental-related causes including mouthwashes, local anaesthetics, latex and antibiotics. The dental team must be able to respond effectively and manage the life-threatening situation appropriately following Resuscitation Council UK guidelines. The timely administration of adrenaline is life-saving; any delays can lead to a poor outcome. With the current national supply issues with adrenaline auto-injector devices, there is an expectation that GDPs should be competent at drawing up adrenaline from an ampoule and administrating it intramuscularly. The aim of this article is to provide an update on the management of anaphylaxis in the dental practice with particular reference to the procedure for intramuscular injection of adrenaline.


Assuntos
Anafilaxia , Anafilaxia/tratamento farmacológico , Anafilaxia/etiologia , Epinefrina/uso terapêutico , Humanos , Injeções Intramusculares
5.
Cochrane Database Syst Rev ; 12: CD012965, 2020 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-33316083

RESUMO

BACKGROUND: Acute bronchiolitis is a significant burden on children, their families and healthcare facilities. It mostly affects children younger than two years of age. Treatment involves adequate hydration, humidified oxygen supplementation, and nebulisation of medications, such as salbutamol, epinephrine, and hypertonic saline. The effectiveness of magnesium sulphate for acute bronchiolitis is unclear. OBJECTIVES: To assess the effects of magnesium sulphate in acute bronchiolitis in children up to two years of age. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, LILACS, CINAHL, and two trials registries to 30 April 2020. We contacted trial authors to identify additional studies. We searched conference proceedings and reference lists of retrieved articles. Unpublished and published studies were eligible for inclusion. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs, comparing magnesium sulphate, alone or with another treatment, with placebo or another treatment, in children up to two years old with acute bronchiolitis. Primary outcomes were time to recovery, mortality, and adverse events. Secondary outcomes were duration of hospital stay, clinical severity score at 0 to 24 hours and 25 to 48 hours after treatment, pulmonary function test, hospital readmission within 30 days, duration of mechanical ventilation, and duration of intensive care unit stay. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We used GRADE methods to assess the certainty of the evidence. MAIN RESULTS: We included four RCTs (564 children). One study received funding from a hospital and one from a university; two studies did not report funding sources. Comparator interventions differed among all four trials. Studies were conducted in Qatar, Turkey, Iran, and India. We assessed two studies to be at an overall low risk of bias, and two to be at unclear risk of bias, overall. The certainty of the evidence for all outcomes and comparisons was very low except for one: hospital re-admission rate within 30 days of discharge for magnesium sulphate versus placebo. None of the studies measured time to recovery, duration of mechanical ventilation, duration of intensive care unit stay, or pulmonary function. There were no events of mortality or adverse effects for magnesium sulphate compared with placebo (1 RCT, 160 children). The effects of magnesium sulphate on clinical severity are uncertain (at 0 to 24 hours: mean difference (MD) on the Wang score 0.13, 95% confidence interval (CI) -0.28 to 0.54; and at 25 to 48 hours: MD on the Wang score -0.42, 95% CI -0.84 to -0.00). Magnesium sulphate may increase hospital re-admission rate within 30 days of discharge (risk ratio (RR) 3.16, 95% CI 1.20 to 8.27; 158 children; low-certainty evidence). None of our primary outcomes were measured for magnesium sulphate compared with hypertonic saline (1 RCT, 220 children). Effects were uncertain on the duration of hospital stay in days (MD 0.00, 95% CI -0.28 to 0.28), and on clinical severity on the Respiratory Distress Assessment Instrument (RDAI) score at 25 to 48 hours (MD 0.10, 95% CI -0.39 to 0.59). There were no events of mortality or adverse effects for magnesium sulphate, with or without salbutamol, compared with salbutamol (1 RCT, 57 children). Effects on the duration of hospital stay were uncertain (magnesium sulphate: 24 hours (95% CI 25.8 to 47.4), magnesium sulphate + salbutamol: 20 hours (95% CI 15.3 to 39.0), and salbutamol: 24 hours (95% CI 23.4 to 76.9)). None of our primary outcomes were measured for magnesium sulphate + epinephrine compared with no treatment or normal saline + epinephrine (1 RCT,120 children). Effects were uncertain for the duration of hospital stay in hours (MD -0.40, 95% CI -3.94 to 3.14), and for RDAI scores (0 to 24 hours: MD -0.20, 95% CI -1.06 to 0.66; and 25 to 48 hours: MD -0.90, 95% CI -1.75 to -0.05). AUTHORS' CONCLUSIONS: There is insufficient evidence to establish the efficacy and safety of magnesium sulphate for treating children up to two years of age with acute bronchiolitis. No evidence was available for time to recovery, duration of mechanical ventilation and intensive care unit stay, or pulmonary function. There was no information about adverse events for some comparisons. Well-designed RCTs to assess the effects of magnesium sulphate for children with acute bronchiolitis are needed. Important outcomes, such as time to recovery and adverse events should be measured.


Assuntos
Bronquiolite/tratamento farmacológico , Broncodilatadores/uso terapêutico , Sulfato de Magnésio/uso terapêutico , Doença Aguda , Albuterol/uso terapêutico , Viés , Broncodilatadores/administração & dosagem , Quimioterapia Combinada/métodos , Epinefrina/uso terapêutico , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Sulfato de Magnésio/administração & dosagem , Readmissão do Paciente/estatística & dados numéricos , Placebos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Solução Salina/uso terapêutico , Índice de Gravidade de Doença
6.
J Int Med Res ; 48(9): 300060520958594, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32962495

RESUMO

OBJECTIVE: Coronavirus disease 2019 (COVID-19) shows a wide range of severity, ranging from an asymptomatic presentation to a severe illness requiring intensive care unit admission. Identification of a strategy to manage the severity of this disease will not only help to reduce its case fatality but also help to remove some of the burden from the already overwhelmed health care systems. While successful management of symptoms in general is important, identifying measures to modify the severity of the illness is a key factor in the fight against this pandemic. METHODS: This paper presents a short literature review to suggest a new treatment modality for COVID-19. RESULTS: COVID-19 is less severe and rarely fatal in children than in adults, which could be caused by greater fluctuations of plasma epinephrine in children. Our literature survey endorses this hypothesis according to both the epidemiological and immunological findings. CONCLUSION: Application of epinephrine pulses with a specific amplitude may be considered an intervention to minimize the severity of COVID-19.


Assuntos
Linfócitos T CD8-Positivos/efeitos dos fármacos , Ritmo Circadiano/efeitos dos fármacos , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Epinefrina/uso terapêutico , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Adulto , Fatores Etários , Doenças Assintomáticas , Biomarcadores/sangue , Linfócitos T CD8-Positivos/imunologia , Linfócitos T CD8-Positivos/virologia , Criança , Ritmo Circadiano/imunologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Esquema de Medicação , Epinefrina/sangue , Epinefrina/imunologia , Humanos , Imunidade Inata/efeitos dos fármacos , Modelos Imunológicos , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , Prognóstico , Índice de Gravidade de Doença
7.
Emerg Med Clin North Am ; 38(4): 819-839, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981620

RESUMO

Pediatric cardiac arrest is a relatively rare but devastating presentation in infants and children. In contrast to adult patients, in whom a primary cardiac dysrhythmia is the most likely cause of cardiac arrest, pediatric patients experience cardiovascular collapse most frequently after an initial respiratory arrest. Aggressive treatment in the precardiac arrest state should be initiated to prevent deterioration and should focus on support of oxygenation, ventilation, and hemodynamics, regardless of the presumed cause. Unfortunately, outcomes for pediatric cardiac arrest, whether in hospital or out of hospital, continue to be poor.


Assuntos
Parada Cardíaca/terapia , Ressuscitação/métodos , Manuseio das Vias Aéreas , Glicemia/análise , Criança , Maus-Tratos Infantis/terapia , Cardioversão Elétrica , Eletroencefalografia , Serviço Hospitalar de Emergência , Epinefrina/uso terapêutico , Oxigenação por Membrana Extracorpórea , Parada Cardíaca/etiologia , Cardiopatias Congênitas/terapia , Frequência Cardíaca , Humanos , Hipotermia/complicações , Hipotermia/terapia , Hipotermia Induzida , Pneumopatias/terapia , Pais , Exame Físico , Envenenamento/terapia , Avaliação de Processos em Cuidados de Saúde , Valores de Referência , Insuficiência Respiratória/terapia , Taxa Respiratória , Ordens quanto à Conduta (Ética Médica) , Sepse/terapia , Choque/etiologia , Choque/terapia , Vasoconstritores/uso terapêutico , Ferimentos e Lesões/terapia
8.
Medicine (Baltimore) ; 99(37): e22074, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925745

RESUMO

Hematological abnormalities at admission are common after traumatic brain injuries and are associated with poor outcomes. The objective of this study was to identify the predictive factors of mortality among patients who underwent emergency surgery for the evacuation of epidural hematoma (EDH) or subdural hematoma (SDH).This was a single-center retrospective cohort study of 200 patients who underwent emergency surgical evacuation of EDH or SDH between September 2010 and December 2018. Data on hematological parameters and clinical and intraoperative features were collected. The primary end-point was 1-year mortality after surgery. Univariate and multivariate analysis were performed, and the receiver operating characteristic (ROC) curves were assessed.Of the 200 patients included in this study, 102 (51%) patients died within 1 year of emergency surgery. Lymphocyte count at admission, creatinine levels, activated partial thromboplastin time (aPTT), age, intraoperative epinephrine use, and Glasgow Coma Scale (GCS) score were significantly associated with mortality in the multivariate analysis. The areas under the ROC curve for the GCS score, aPTT, and lymphocyte counts were 0.677 (95% confidence interval [CI] 0.602-0.753), 0.644 (95% CI 0.567-0.721), and 0.576 (95% CI 0.496-0.656), respectively.Patients with elevated lymphocyte counts on admission showed a higher rate of 1-year mortality following emergency craniectomy for EDH or SDH. In addition, prolonged aPTT and a lower GCS score were also related to poor survival.


Assuntos
Hematoma Epidural Craniano/sangue , Hematoma Epidural Craniano/cirurgia , Hematoma Subdural Intracraniano/sangue , Hematoma Subdural Intracraniano/cirurgia , Adulto , Idoso , Biomarcadores/sangue , Craniotomia , Creatinina/sangue , Serviço Hospitalar de Emergência , Epinefrina/uso terapêutico , Feminino , Escala de Coma de Glasgow , Hematoma Epidural Craniano/mortalidade , Hematoma Subdural Intracraniano/mortalidade , Humanos , Período Intraoperatório , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Tempo de Tromboplastina Parcial , Prognóstico , Estudos Retrospectivos , Vasoconstritores/uso terapêutico
9.
Med. oral patol. oral cir. bucal (Internet) ; 25(5): e634-e643, sept. 2020. ilus, tab, graf
Artigo em Inglês | IBECS | ID: ibc-196519

RESUMO

BACKGROUND: Hemostasis is of critical importance in endodontic surgery. Studies on bleeding control in maxillary molars are scarce. The present study compares the efficacy of two hemostatic techniques in controlling bleeding in endodontic surgery. MATERIAL AND METHODS: A randomized two-arm pilot study involving 30 patients with peri-radicular lesions in maxillary molars (first and second molars) was carried out including the following hemostatic agents: polytetrafluoroethylene (PTFE) strips as an adjunct to epinephrine impregnated gauze (test group; n = 15) and aluminum chloride (Expasyl(TM)) (control; n = 15). Bleeding control was independently assessed by the surgeon and by two blinded observers before and after application of the hemostatic agent, and was classified as either adequate (complete bleeding control) or inadequate (incomplete bleeding control). RESULTS: Bleeding control was similar in both groups. Simple binary logistic regression analysis failed to identify variables affecting bleeding control. Only the height of the keratinized mucosal band (≥ 2 mm) suggested a decreased risk of inadequate bleeding control of up to 89% (OR = 0.11; p = 0.06). CONCLUSIONS: No difference in the efficacy of bleeding control was observed between PTFE strips as an adjunct to epinephrine impregnated gauze and aluminum chloride in maxillary molars


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Hemostasia Cirúrgica/métodos , Raiz Dentária/cirurgia , Cavidade Pulpar/cirurgia , Hemostáticos/uso terapêutico , Dente Molar/cirurgia , Politetrafluoretileno/uso terapêutico , Epinefrina/uso terapêutico , Cloreto de Alumínio/uso terapêutico , Tratamento do Canal Radicular/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Modelos Logísticos , Resultado do Tratamento , Maxila/cirurgia
10.
J Allergy Clin Immunol Pract ; 8(9): 2845-2850, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32711118

RESUMO

In the wake of the COVID-19 pandemic and massive disruptions to daily life in the spring of 2020, in May 2020, the Centers for Disease Control (CDC) released guidance recommendations for schools regarding how to have students attend while adhering to principles of how to reduce the risk of contracting SARS-CoV-2. As part of physical distancing measures, the CDC is recommending that schools who traditionally have had students eat in a cafeteria or common large space instead have children eat their lunch or other meals in the classroom at already physically distanced desks. This has sparked concern for the safety of food-allergic children attending school, and some question of how the new CDC recommendations can coexist with recommendations in the 2013 CDC Voluntary Guidelines on Managing Food Allergy in Schools as well as accommodations that students may be afforded through disability law that may have previously prohibited eating in the classroom. This expert consensus explores the issues related to evidence-based management of food allergy at school, the issues of managing the health of children attending school that are acutely posed by the constraints of an infectious pandemic, and how to harmonize these needs so that all children can attend school with minimal risk from both an infectious and allergic standpoint.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Epinefrina/uso terapêutico , Hipersensibilidade Alimentar/tratamento farmacológico , Hipersensibilidade Alimentar/prevenção & controle , Capacitação em Serviço/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Serviços de Saúde Escolar , Adolescente , Agonistas alfa-Adrenérgicos/uso terapêutico , Anafilaxia , Centers for Disease Control and Prevention, U.S. , Criança , Pessoal de Educação/educação , Humanos , Guias de Prática Clínica como Assunto , Instituições Acadêmicas , Estados Unidos
11.
Pediatrics ; 146(1)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32532791

RESUMO

BACKGROUND: Neonatal-perinatal medicine (NPM) fellowship programs must provide adequate delivery room (DR) experience to ensure that physicians can independently provide neonatal resuscitation to very low birth weight (VLBW) infants. The availability of learning opportunities is unknown. METHODS: The number of VLBW (≤1500 g) and extremely low birth weight (ELBW) (<1000 g) deliveries, uses of continuous positive airway pressure, intubation, chest compressions, and epinephrine over 3 years at accredited civilian NPM fellowship program delivery hospitals were determined from the Vermont Oxford Network from 2012 to 2017. Using Poisson distributions, we estimated the expected probabilities of fellows experiencing a given number of cases over 3 years at each program. RESULTS: Of the 94 NPM fellowships, 86 programs with 115 delivery hospitals and 62 699 VLBW deliveries (28 703 ELBW) were included. During a 3-year fellowship, the mean number of deliveries per fellow ranged from 14 to 214 (median: 60) for VLBWs and 7 to 107 (median: 27) for ELBWs. One-half of fellows were expected to see ≤23 ELBW deliveries and 52 VLBW deliveries, 24 instances of continuous positive airway pressure, 23 intubations, 2 instances of chest compressions, and 1 treatment with epinephrine. CONCLUSIONS: The number of opportunities available to fellows for managing VLBW and ELBW infants in the DR is highly variable among programs. Fellows' exposure to key, high-risk DR procedures such as cardiopulmonary resuscitation is low at all programs. Fellowship programs should track fellow exposure to neonatal resuscitations in the DR and integrate supplemental learning opportunities. Given the low numbers, the number of new and existing NPM programs should be considered.


Assuntos
Neonatologia/educação , Ressuscitação/educação , Pressão Positiva Contínua nas Vias Aéreas , Epinefrina/uso terapêutico , Bolsas de Estudo , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Intubação , Ressuscitação/métodos , Vermont
12.
Curr Opin Crit Care ; 26(4): 411-416, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32487842

RESUMO

PURPOSE OF REVIEW: Data and interventional trials on vasopressor use during cardiogenic shock are scarce. Their use is limited by their side-effects and the lack of solid evidence regarding their effectiveness in improving outcomes. In the present article, we review the current use of vasopressor therapy during cardiogenic shock. RECENT FINDINGS: Two recent Cochrane analyses concluded that there was insufficient evidence to prove that any one vasopressor was superior to others in terms of mortality. A recent RCT and a meta-analysis on individual data suggested that norepinephrine may be preferred over epinephrine in patients with cardiogenic shock, in particular, after myocardial infarction. In patients with right ventricular failure and pulmonary hypertension, the use of vasopressin may be advocated under advanced monitoring. SUMMARY: When blood pressure needs to be restored, norepinephrine is a reasonable first-line agent. Information regarding comparative effective outcomes is sparse and their use should be limited to a temporary measure as a bridge to recovery, mechanical circulatory support or heart transplantation.


Assuntos
Insuficiência Cardíaca , Choque Cardiogênico , Epinefrina/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Norepinefrina/uso terapêutico , Choque Cardiogênico/tratamento farmacológico , Vasoconstritores/uso terapêutico
13.
J Shoulder Elbow Surg ; 29(7): 1310-1315, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32553436

RESUMO

BACKGROUND: We investigated the effectiveness of cocktail therapy after arthroscopic rotator cuff repair (ARCR). METHODS: We evaluated 128 shoulders undergoing ARCR and used block randomization to divide patients into 2 groups in this double-blind trial: The cocktail group received 20 mL of 0.75% ropivacaine, 5 mg of morphine, 0.3 mg of epinephrine, 2 mg of betamethasone, and saline solution to a total of 42 mL, whereas the control group received 20 mL of 0.75% ropivacaine and saline solution to a total of 42 mL. Postoperatively, one of the drug mixtures was injected into the glenohumeral joint, subacromial bursa, suprascapular nerve, and anterior, middle, and posterior parts of the deltoid muscle according to the treatment group. We recorded patients' visual analog scale scores preoperatively and at 4, 8, 16, 24, and 48 hours postoperatively; the number of patients using postoperative diclofenac suppositories and buprenorphine hydrochloride; the number of patients experiencing nausea; the number of patients with infection and delayed wound healing as adverse effects; the surgery time; the retear rate; and passive shoulder range of motion. RESULTS: The cocktail group constituted 64 shoulders (50.0%), with 39 men (60.9%) and 25 women (39.1%); the mean age was 64.2 ± 10.2 years. The control group constituted 64 shoulders (50.0%), with 41 men (64.1%) and 23 women (35.9%); the mean age was 65.2 ± 7.5 years. We found no significant difference in age or sex between the 2 groups. There was also no significant difference in rotator cuff tear size or surgery time between the 2 groups. The visual analog scale scores at 8, 16, and 24 hours postoperatively were significantly lower in the cocktail group. The number of patients using suppositories was also significantly lower in the cocktail group. The number of patients receiving buprenorphine injections tended to be lower in the cocktail group, but the difference was not significant. Nausea occurred in 6.3% of patients in the cocktail group and 15.6% in the control group, but the difference was not significant. No infection or delayed wound healing occurred in either group. There was no significant difference in the retear rate between the 2 groups. Passive anterior elevation at 3 months postoperatively was significantly better in the cocktail group than in the control group. CONCLUSION: We compared cocktail therapy and ropivacaine after ARCR and found no difference in results except for VAS score at 8, 16, and 24 hours postoperatively and frequency of postoperative suppository use without an apparent risk of infection or a detrimental effect on tendon healing.


Assuntos
Anestésicos Locais/uso terapêutico , Artroscopia/efeitos adversos , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Ropivacaina/uso terapêutico , Lesões do Manguito Rotador/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Betametasona/uso terapêutico , Buprenorfina/uso terapêutico , Diclofenaco/uso terapêutico , Método Duplo-Cego , Quimioterapia Combinada , Epinefrina/uso terapêutico , Feminino , Humanos , Injeções Intra-Articulares , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Morfina/uso terapêutico , Náusea/etiologia , Bloqueio Nervoso , Duração da Cirurgia , Amplitude de Movimento Articular , Recidiva , Ropivacaina/administração & dosagem , Articulação do Ombro , Infecção da Ferida Cirúrgica/etiologia , Vasoconstritores/uso terapêutico , Cicatrização
14.
Pediatr Rev ; 41(6): 283-292, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32482691

RESUMO

Urticaria and, to a lesser extent, angioedema are common occurrences in the pediatric population. There are multiple causes of acute and chronic urticaria and angioedema. Most causes are benign, although they can be worrisome for patients and their parents. An allergist should evaluate acute urticaria and/or angioedema if there are concerns of an external cause, such as foods or medications. Chronic urticaria and angioedema can severely affect quality of life and should be managed aggressively with antihistamines and immunomodulators if poorly controlled. Chronic symptoms are unlikely to be due to an external cause. Anaphylaxis is a more serious allergic condition characterized by a systemic reaction involving at least 2 organ systems. Anaphylaxis should be initially managed with intramuscular epinephrine. Patients who experience anaphylaxis should be evaluated by an allergist for possible causes; if found, avoidance of the inciting antigen is the best management. All patients should also be given an epinephrine autoinjector and an action plan. Foods are a common cause of anaphylaxis in the pediatric population. New evidence suggests that the introduction of highly allergic foods is safe in infancy and should not be delayed. In addition, the early introduction of foods such as peanuts may help prevent the development of food allergies.


Assuntos
Anafilaxia/etiologia , Angioedema/etiologia , Antialérgicos/uso terapêutico , Epinefrina/uso terapêutico , Hipersensibilidade Alimentar/diagnóstico , Antagonistas dos Receptores Histamínicos/uso terapêutico , Urticária/etiologia , Adolescente , Anafilaxia/tratamento farmacológico , Angioedema/tratamento farmacológico , Criança , Feminino , Hipersensibilidade Alimentar/complicações , Hipersensibilidade Alimentar/prevenção & controle , Humanos , Imunoterapia , Masculino , Omalizumab/uso terapêutico , Urticária/tratamento farmacológico
15.
Am J Emerg Med ; 38(9): 1987.e1-1987.e3, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32456834

RESUMO

The emergency department (ED) is responsible for managing a variety of acute illnesses including undifferentiated shock. A newer less recognized syndrome termed BRASH - bradycardia, renal failure, AV-node blockers, shock and hyperkalemia - is a cycle of synergy between hyperkalemia and AV-blockade that can result in shock. This entity is more common amongst the elderly, considering polypharmacy and co-morbid diseases. Some cases have an inciting trigger of hypovolemia. Anaphylaxis is a potentially lethal form of shock that most emergency physicians (EP) treat in the ED. The two entities have never occurred simultaneously. Herein, we report a case of anaphylaxis induced BRASH syndrome occurring in an elderly diabetic man. The EP should be aware of this unique presentation of BRASH. It was concluded that the patient's anaphylaxis, caused hypovolemia, coupled with polypharmacy, and physiological stress, precipitated this severe form of shock and multi-organ system failure.


Assuntos
Anafilaxia/complicações , Bloqueio Atrioventricular/etiologia , Bradicardia/etiologia , Hiperpotassemia/etiologia , Insuficiência Renal/etiologia , Choque/etiologia , Idoso , Serviço Hospitalar de Emergência , Epinefrina/uso terapêutico , Humanos , Masculino
16.
Int Arch Allergy Immunol ; 181(7): 529-535, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32460300

RESUMO

BACKGROUND: Hymenoptera venom allergy (HVA) has a prevalence of 3% in adults. Although patients have no ongoing symptoms, they often suffer from an impairment of their psychological well-being and quality of life. OBJECTIVE: The aim of this study was to analyze sex-specific differences regarding the psychological burden caused by this allergy and handling of the emergency medication. METHOD: Study participants filled out a questionnaire including sociodemographic and disease-specific characteristics, the Hospital Anxiety and Depression Score (HADS), and theoretical knowledge about the emergency medication set (EMS). Additionally, an objective structured clinical examination was used to assess practical knowledge and handling of the EMS. RESULTS: Fifty-six patients were included (55.4% females). Female patients showed higher subjective anxiety levels due to HVA compared to men (mean 7.2 vs. 4.6, p = 0.0003). Furthermore, the HADS revealed that women had a significant higher anxiety level, especially after Mueller grade I-II anaphylactic reactions (mean 6.3 vs. 2.8, p = 0.0134). This was associated with a higher theoretical but not practical knowledge about their disease. On the other hand, males were less inclined to carry the emergency medication "always" or "almost always" (56 vs. 87.1%, p = 0.0015) but showed higher self-assurance in using it (mean 7.3 vs. 6.1, p = 0.0446). CONCLUSIONS: This clinical study provides evidence for sex differences in coping with HVA. The results suggest that females should be monitored more closely for allergy-associated anxiety symptoms, while men need more encouragement to carry the emergency medication.


Assuntos
Anafilaxia/etiologia , Venenos de Artrópodes/efeitos adversos , Venenos de Artrópodes/imunologia , Conhecimentos, Atitudes e Prática em Saúde , Hipersensibilidade/imunologia , Mordeduras e Picadas de Insetos/complicações , Adulto , Anafilaxia/prevenção & controle , Animais , Ansiedade/etiologia , Broncodilatadores/uso terapêutico , Epinefrina/uso terapêutico , Feminino , Humanos , Hipersensibilidade/psicologia , Mordeduras e Picadas de Insetos/imunologia , Masculino , Pessoa de Meia-Idade , Angústia Psicológica , Fatores Sexuais
20.
Medicine (Baltimore) ; 99(11): e19040, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176031

RESUMO

Traditional high ligation and stripping (THLS) is a routine operation for varicose veins. However, THLS is accompanied with postoperative subcutaneous ecchymosis and pain. In this current study, we aimed to explore the effect of tumescence solution (TS) combined with negative pressure wound therapy (NPWT) on the relief of subcutaneous ecchymosis and pain after THLS of great saphenous vein.A total of 180 patients receiving THLS were enrolled in group A, and 120 patients undergoing THLS and TS combined with NPWT were assigned into group B. The occurrences of subcutaneous ecchymosis and pain were recorded. Moreover, the total area of subcutaneous ecchymosis was estimated by the grid method. Visual analogue scale (VAS) score was used to assess the pain level of both groups.Preoperative characteristics were not significantly different between 2 groups. Postoperative ecchymosis occurred in 112 cases (62.2%) of group A and 41 cases (34.2%) of group B. The area of ecchymosis in group A (66.6 ±â€Š44.5) cm was larger than that in group B (25.2 ±â€Š19.9) cm. The number of patients without obvious pain in group A (57, 31.7%) was significantly less than that in group B (77, 64.2%) after operation. In addition, VAS score in group A (3.1 ±â€Š2.6) was higher than that in group B (2.2 ±â€Š1.9).In conclusion, the application of TS combined with NPWT in THLS can not only alleviate subcutaneous ecchymosis and pain, but also prevent the occurrence of subcutaneous ecchymosis and pain after operation. Therefore, it is conducive to postoperative recovery and is suitable for clinical application.


Assuntos
Equimose/terapia , Epinefrina/uso terapêutico , Tratamento de Ferimentos com Pressão Negativa/métodos , Ropivacaina/uso terapêutico , Veia Safena/cirurgia , Varizes/cirurgia , Adulto , Epinefrina/administração & dosagem , Feminino , Humanos , Masculino , Dor Pós-Operatória/terapia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Ropivacaina/administração & dosagem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...