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1.
Arch. pediatr. Urug ; 92(2): e305, dic. 2021. tab
Artigo em Espanhol | LILACS, BNUY, UY-BNMED | ID: biblio-1278305

RESUMO

Las afecciones respiratorias agudas son la primera causa de consulta e ingreso hospitalario en los meses de invierno, y entre ellas el asma ocupa un lugar preponderante. El salbutamol es un broncodilatador con eficacia demostrada en las exacerbaciones y se utiliza de primera línea en el tratamiento. El objetivo de la presente comunicación es analizar dos casos clínicos de niños asmáticos que presentaron efectos adversos al salbutamol y requirieron el ingreso en la Unidad de Terapia Intensiva. Se propone revisar los efectos adversos del salbutamol empleado en crisis asmáticas y analizar las alternativas terapéuticas en esta enfermedad. Los síntomas de los efectos secundarios pueden confundirse con los causados por la propia enfermedad, por lo que puede usarse el fármaco de modo excesivo y es importante conocer el perfil posológico y caracterizar los posibles efectos secundarios en los pacientes para usar de manera racional y segura este medicamento.


Acute respiratory conditions are the first cause of consultation and hospital admission in the Winter months, being asthma the most important. Salbutamol is a bronchodilator with proven efficacy in exacerbations used first-line in treatment. The objective of this paper is to analyze two clinical cases of asthmatic children who presented adverse effects to salbutamol and required admission to the Intensive Care Unit. It is proposed to review the adverse effects of salbutamol used in asthmatic crises and to analyze therapeutic alternatives in this disease. Symptoms of side effects can be confused with those caused by the disease itself, determining the excessive use of this drug, thus, it is important to know the dosage profile and characterize the possible side effects to make rational and safe use of this drug.


As doenças respiratórias agudas são a primeira causa de consultas e internações nos meses de inverno e a asma ocupa é a mais importante. O salbutamol é um broncodilatador com eficácia comprovada nas exacerbações e é usado como tratamento de primeira linha. O objetivo desta comunicação é analisar dois casos clínicos de crianças asmáticas que apresentaram efeitos adversos ao salbutamol e necessitaram de internação em Unidade de Terapia Intensiva. Propõe-se revisar os efeitos adversos do salbutamol utilizado na crise asmática e analisar as alternativas terapêuticas nessa doença. Os sintomas de efeitos colaterais podem ser confundidos com os causados pela própria doença, determinando o uso excessivo desse medicamento, sendo importante conhecer o perfil posológico e caracterizar os possíveis efeitos colaterais nos pacientes para fazer um uso racional e seguro desse medicamento.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Acidose Láctica , Broncodilatadores/efeitos adversos , Albuterol/efeitos adversos , Hiperglicemia/induzido quimicamente , Hipopotassemia/induzido quimicamente , Agitação Psicomotora/etiologia , Recidiva , Asma/tratamento farmacológico , Taquicardia/induzido quimicamente , Tremor/induzido quimicamente , Alucinações/induzido quimicamente
2.
Medicine (Baltimore) ; 100(41): e27469, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34731124

RESUMO

BACKGROUND: We conducted this meta-analysis to explore the tolerance of monotherapy with mirabegron (50 mg) on an overactive bladder, compared with a common dosage of anticholinergic agents. MATERIALS AND METHODS: A comprehensive search for all randomized controlled trials that evaluated the safety of mirabegron and anticholinergic agents on overactive bladder was performed, and we searched the Cochrane Central Register of Controlled trials databases, Pubmed, Embase, and relevant trials from 2013.02 to 2019.10. RESULTS: Eight studies included 5500 patients with treatment of monotherapy on overactive bladder were identified. The total number of treatment-emergent adverse events had no significantly difference between two monotherapies (RR = 0.88 95%CI: 0.76-1.01; P = .08); however, patients would have a better tolerance with mirabegron (50 mg) in adverse events of dry mouth (RR = 0.42; 95%CI: 0.33-0.53; P < .01) and tachycardia (RR = 0.52; 95%CI: 0.29-0.94; P = .03); and there were no significant differences between two groups in hypertension (RR = 1.02; 95%CI: 0.80-1.30; P = .90), constipation (RR = 0.91; 95%CI: 0.65-1.26; P = 0.57), blurred vision (RR = 1.03; 95%CI: 0.60-1.77; P = 0.92), and urinary tract infection (RR = 0.90; 95%CI: 0.70-1.16; P = .41). CONCLUSIONS: Treatment-emergent adverse events in patients with overactive bladder who underwent monotherapy of mirabegron (50 mg) or the anticholinergic agents had no significant differences, but mirabegron has a better tolerance in the aspect of dry mouth and tachycardia.


Assuntos
Acetanilidas/uso terapêutico , Agonistas de Receptores Adrenérgicos beta 3/uso terapêutico , Antagonistas Colinérgicos/uso terapêutico , Tiazóis/uso terapêutico , Bexiga Urinária Hiperativa/tratamento farmacológico , Acetanilidas/administração & dosagem , Acetanilidas/efeitos adversos , Agonistas de Receptores Adrenérgicos beta 3/administração & dosagem , Agonistas de Receptores Adrenérgicos beta 3/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Antagonistas Colinérgicos/efeitos adversos , Constipação Intestinal/induzido quimicamente , Constipação Intestinal/epidemiologia , Feminino , Humanos , Hipertensão/induzido quimicamente , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Segurança , Taquicardia/induzido quimicamente , Taquicardia/epidemiologia , Tiazóis/administração & dosagem , Tiazóis/efeitos adversos , Infecções Urinárias/induzido quimicamente , Infecções Urinárias/epidemiologia , Baixa Visão/induzido quimicamente , Baixa Visão/epidemiologia , Xerostomia/induzido quimicamente , Xerostomia/epidemiologia
3.
Am J Emerg Med ; 48: 218-223, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33975134

RESUMO

INTRODUCTION: Cannabidiol (CBD) has become a popular supplement in consumer products in recent years, resulting in part from normalization of the cultivation of low THC cannabis in 2018. However, the actual content of CBD-labeled products is frequently uncertain, as oversight of such products is minimal. To date, there is little pragmatic knowledge regarding exposures to products labeled as containing CBD. METHODS: Cases reported to Poison Control Centers from April 1, 2019 and March 31, 2020, the first year in which CBD was identified uniquely as a substance in the National Poison Data System, were analyzed for demographic, temporal, and clinical trends. RESULTS: Poison Control Centers handled 1581 cases exposures to CBD-containing products between April 1, 2019 and March 31, 2020. There was a significant trend of over 5 additional cases related to this substance per month (linear regression coefficient = 5.2, 95% CI: 1.52-8.98). Patients under age 13 years made up 44.0% of reported exposures. Mild CNS depression (10.3%), tachycardia (5.7%), dizziness/vertigo (5.3%), vomiting (4.9%), nausea (4.5%), and agitation (4.4%) were the most frequently reported symptoms. 13% of cases were coded as having "moderate" or "severe" medical outcomes. There were no fatalities. CONCLUSIONS: Cases reported to Poison Control Centers regarding exposures to CBD-labeled products have been increasing, representing an emerging trend of interest to Poison Control Center professionals, clinicians, and public health officials. Further monitoring of this trend is recommended.


Assuntos
Anticonvulsivantes/envenenamento , Canabidiol/envenenamento , Síndromes Neurotóxicas/epidemiologia , Centros de Controle de Intoxicações , Adolescente , Adulto , Idoso , Anticonvulsivantes/efeitos adversos , Canabidiol/efeitos adversos , Criança , Pré-Escolar , Bases de Dados Factuais , Tontura/induzido quimicamente , Tontura/epidemiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Náusea/epidemiologia , Síndromes Neurotóxicas/etiologia , Taquicardia/induzido quimicamente , Taquicardia/epidemiologia , Estados Unidos/epidemiologia , Vertigem/induzido quimicamente , Vertigem/epidemiologia , Vômito/induzido quimicamente , Vômito/epidemiologia , Adulto Jovem
4.
Clin Toxicol (Phila) ; 59(10): 937-941, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33688777

RESUMO

BACKGROUND: Caffeine poisoning may cause life-threatening arrhythmias and hemodynamic failure. We aimed to investigate the toxicokinetics (TK), toxicodynamics (TD) and TK/TD relationships of caffeine in a case of poisoning. CASE REPORT: A 47-year-old male ingested pure anhydrous caffeine powder (70 g) in a suicide attempt. He developed agitation, tachycardia, and two episodes of ventricular fibrillation treated with defibrillation and tracheal intubation. He was successfully managed using intravenous infusions of esmolol and norepinephrine. METHODS: We modelled the time-course of plasma caffeine concentration (TK study using online liquid chromatography-tandem mass spectrometry), the time-course of blood lactate concentration and infusion rates of esmolol and norepinephrine (TD studies) and the TK/TD relationships. RESULTS: Caffeine TK was of first-order peaking at 258 mg/L with an elimination half-life of 46.2 h and clearance of 2.2 L/h. Caffeine-related effects on blood lactate (peak, 10 mmol/L at 1.25 h postingestion) were described by a Bateman-type equation (formation rate, 0.05 mmol/mg.h; elimination rate, 0.9 mmol/mg.h). Esmolol and norepinephrine infusion rates to reverse caffeine-related cardiovascular effects (peaks at 51-h postingestion) fitted well with a sigmoidal Emax model (EC50, 180.0 and 225.9 mg/L, respectively; Hill coefficient, 10.0). CONCLUSION: Massive caffeine ingestion is characterized by prolonged caffeine elimination. TK/TD relationships are helpful to quantify caffeine-related catecholaminergic effects.


Assuntos
Cafeína/envenenamento , Estimulantes do Sistema Nervoso Central/envenenamento , Frequência Cardíaca/efeitos dos fármacos , Tentativa de Suicídio , Taquicardia/induzido quimicamente , Fibrilação Ventricular/induzido quimicamente , Administração Oral , Agonistas alfa-Adrenérgicos/administração & dosagem , Antagonistas de Receptores Adrenérgicos beta 1/administração & dosagem , Cafeína/administração & dosagem , Cafeína/farmacocinética , Cardiotoxicidade , Estimulantes do Sistema Nervoso Central/administração & dosagem , Estimulantes do Sistema Nervoso Central/farmacocinética , Cardioversão Elétrica , Meia-Vida , Humanos , Hiperlactatemia/induzido quimicamente , Infusões Intravenosas , Intubação Intratraqueal , Masculino , Taxa de Depuração Metabólica , Pessoa de Meia-Idade , Norepinefrina/administração & dosagem , Pós , Propanolaminas/administração & dosagem , Taquicardia/diagnóstico , Taquicardia/fisiopatologia , Taquicardia/terapia , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/fisiopatologia , Fibrilação Ventricular/terapia
5.
J Am Acad Dermatol ; 84(6): 1644-1651, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33639244

RESUMO

BACKGROUND: The major concern regarding the use of low-dose oral minoxidil (LDOM) for the treatment of hair loss is the potential risk of systemic adverse effects. OBJECTIVE: To describe the safety of LDOM for the treatment of hair loss in a large cohort of patients. METHODS: Retrospective multicenter study of patients treated with LDOM for at least 3 months for any type of alopecia. RESULTS: A total of 1404 patients (943 women [67.2%] and 461 men [32.8%]) with a mean age of 43 years (range 8-86) were included. The dose of LDOM was titrated in 1065 patients, allowing the analysis of 2469 different cases. The most frequent adverse effect was hypertrichosis (15.1%), which led to treatment withdrawal in 14 patients (0.5%). Systemic adverse effects included lightheadedness (1.7%), fluid retention (1.3%), tachycardia (0.9%), headache (0.4%), periorbital edema (0.3%), and insomnia (0.2%), leading to drug discontinuation in 29 patients (1.2%). No life-threatening adverse effects were observed. LIMITATIONS: Retrospective design and lack of a control group. CONCLUSION: LDOM has a good safety profile as a treatment for hair loss. Systemic adverse effects were infrequent and only 1.7% of patients discontinued treatment owing to adverse effects.


Assuntos
Alopecia/tratamento farmacológico , Minoxidil/efeitos adversos , Administração Oral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Tontura/induzido quimicamente , Tontura/epidemiologia , Edema/induzido quimicamente , Edema/epidemiologia , Feminino , Cefaleia/induzido quimicamente , Cefaleia/epidemiologia , Humanos , Hipertricose/induzido quimicamente , Hipertricose/epidemiologia , Masculino , Pessoa de Meia-Idade , Minoxidil/administração & dosagem , Estudos Retrospectivos , Distúrbios do Início e da Manutenção do Sono/induzido quimicamente , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Taquicardia/induzido quimicamente , Taquicardia/epidemiologia , Adulto Jovem
7.
J Med Case Rep ; 15(1): 11, 2021 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-33451341

RESUMO

BACKGROUND: Caffeine is a widely used dietary stimulant, and cases of caffeine overdoses, sometimes leading to death, are increasing. We encountered a case of caffeine intoxication resolved with administration of the sedative agent dexmedetomidine. CASE PRESENTATION: We administered dexmedetomidine for sedation and to suppress sympathetic nerve stimulation in the case of an 18-year-old Japanese male who ingested a massive dose of caffeine with the intention of committing suicide. The patient was in an excited state and had hypertension, sinus tachycardia, and hypokalemia with prominent QT prolongation. After dexmedetomidine administration, the patient's mental state, hemodynamics, and electrolyte levels were improved immediately. He was discharged without any sequelae 3 days later. CONCLUSION: Cases of acute caffeine intoxication with agitation, sympathetic overactivity and adverse cardiac events would benefit with dexmedetomidine treatment.


Assuntos
Cafeína/envenenamento , Estimulantes do Sistema Nervoso Central/envenenamento , Dexmedetomidina/uso terapêutico , Overdose de Drogas/tratamento farmacológico , Hipnóticos e Sedativos/uso terapêutico , Tentativa de Suicídio , Acidose Láctica/induzido quimicamente , Acidose Láctica/tratamento farmacológico , Adolescente , Antídotos/uso terapêutico , Carvão Vegetal/uso terapêutico , Eletrocardiografia , Lavagem Gástrica , Humanos , Hipertensão/induzido quimicamente , Hipertensão/tratamento farmacológico , Hipopotassemia/induzido quimicamente , Hipopotassemia/tratamento farmacológico , Síndrome do QT Longo/induzido quimicamente , Síndrome do QT Longo/tratamento farmacológico , Masculino , Potássio/uso terapêutico , Taquicardia/induzido quimicamente , Taquicardia/tratamento farmacológico
8.
Am J Forensic Med Pathol ; 42(3): 286-288, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-33491946

RESUMO

ABSTRACT: Forensic pathologists may sometimes encounter cases of suicide with ingestion of unusual compounds. Herein, we describe a case of suicide by ingestion of barium acetate. Deaths by ingestion of this compound have not previously been reported in literature. This case shows the clinical presentation of the toxicity of barium compounds and highlights the importance of scene investigation and clinicopathologic correlation in suicides by unusual ingestion.


Assuntos
Compostos de Bário/envenenamento , Suicídio Consumado , Adulto , Eletrocardiografia , Feminino , Humanos , Hipopotassemia/induzido quimicamente , Taquicardia/induzido quimicamente
9.
Eur J Obstet Gynecol Reprod Biol ; 256: 354-357, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33276280

RESUMO

OBJECTIVES: The aim of this study is to evaluate the prevalence of maternal complications derived from digoxin treatment and its relationship with digoxinemia, as well as its occurrence in relation to the different treatment doses and therapeutic schemes used. STUDY DESIGN: This is a retrospective observational study of women who received digoxin for the treatment of fetal tachyarrhythmia over a 10-year period at the University Hospital Virgen del Rocío (Seville). Data corresponding to the digoxin dose, its duration, serum digoxin levels and electrocardiographic parameters during follow-up were collected. Maternal side effects were reported, and its relationship to the treatment dose as well as digoxinemia. The study is accompanied by a narrative review of related literature. RESULTS: There were 10 cases eligible. During treatment, as least one symptom or sign was present in 30 % of cases, being in all cases digestive symptoms. In all those cases, the digoxin level was higher than established as therapeutic threshold (2 ng/mL), and all reversed within a maximum of 48 h after the dose decrease. Digoxinemia overdosing (> 2 ng/mL) was observed in 6 women (60 %), one of which reached the toxicity range (> 3 ng/mL). In all cases, normal range was achieved decreasing the dose of digoxin 0.25 mg every 24 h. No patient developed side effects with digoxinemia below 2 ng/mL. No electrocardiographic abnormalities appeared during treatment. CONCLUSION: Digoxin is a safe treatment for management of fetal tachyarrhythmias. Side effects appear frequently when serum digoxin level is over 2 ng/mL, but they are usually mild and self-limited. However, it remains advisable to monitor electrocardiographic changes and digoxinemia through the whole therapy to prevent serious complications related to digoxin toxicity.


Assuntos
Digoxina , Herança Materna , Digoxina/efeitos adversos , Eletrocardiografia , Feminino , Humanos , Estudos Observacionais como Assunto , Estudos Retrospectivos , Taquicardia/induzido quimicamente , Taquicardia/tratamento farmacológico
10.
Am J Perinatol ; 38(3): 291-295, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-31550735

RESUMO

OBJECTIVE: The aim of the study is to obtain insights on the short and long-term safety and effectiveness of isoxsuprine hydrochloride as a tocolytic agent in the management of PTL. STUDY DESIGN: In this prospective, single-center, noncomparative study, patients (with preterm labor at gestational age of 24-37 weeks) were administered intravenous (IV) infusion of 40-mg isoxsuprine hydrochloride until uterine quiescence, followed by intramuscular (IM) injection of isoxsuprine hydrochloride 10 mg/4-hourly for first 24 hours and maintained with retard 40-mg sustained release capsule (two times a day) till the time of delivery or 37 completed weeks of pregnancy. RESULTS: All patients (n = 50) achieved successful tocolysis in 24 hours and 48 hours postadministration of isoxsuprine hydrochloride (IV/IM/oral). Mean (±SD) gestation age at the time of delivery was 39.8 ± 2.1 weeks, with latency period of 58.5 ± 18.7 days. Pregnancy outcomes were normal in all the patients and no congenital anomaly/fetal infection was reported. Mean (±SD) fetal birth weight was 2.7 ± 0.3 kg; mean (±SD) Apgar score at 1 and 5 minutes were 7.5 ± 0.6 and 9.2 ± 0.4, respectively. Maternal tachycardia and vomiting (8.0% each) were the commonly reported adverse drug reactions, which were resolved with dose adjustment. CONCLUSION: Isoxsuprine was found to be an effective and well-tolerated tocolytic agent in arresting PTL, in turn resulting in the overall improvement in maternal and perinatal outcomes.


Assuntos
Isoxsuprina/administração & dosagem , Trabalho de Parto Prematuro/tratamento farmacológico , Tocólise/métodos , Tocolíticos/administração & dosagem , Adulto , Feminino , Idade Gestacional , Humanos , Índia , Recém-Nascido , Injeções Intramusculares , Isoxsuprina/efeitos adversos , Gravidez , Resultado da Gravidez , Nascimento Prematuro/prevenção & controle , Estudos Prospectivos , Taquicardia/induzido quimicamente , Tocolíticos/efeitos adversos , Vômito/induzido quimicamente , Adulto Jovem
12.
Rev Saude Publica ; 54: 133, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33331527

RESUMO

OBJECTIVE: To explore the association of occupational pesticide exposure with acute and mental health symptoms. METHODS: Cross-sectional survey carried out with 78 Brazilian family farmers, who were pesticide applicators and helpers conveniently selected. Symptoms and exposure data were collected by interviews, and mental health outcomes by the Self-Reporting Questionnaire. Blood samples were analyzed to assess cholinesterase levels. Exposure indicators and symptoms were compared between applicators and helpers, and Poisson regression was performed to estimate prevalence ratios. RESULTS: Farmers reported exposure to multiple pesticides from early ages; they worked without safety training, technical support, and full protective equipment, and they had a high prevalence of acute and mental health symptoms (e.g., headache, mucosal irritation, tachycardia, and depressive signs). Applicators had more cholinesterase changes than helpers, but less symptoms. Helpers used less personal protection and had significantly higher prevalence ratio of headache, dyspnea, wheezing, cough, poor digestion, tiredness, and feeling worthless, after adjustment. CONCLUSIONS: Acute and mental health symptoms were observed, both among farmers and helpers. Thus, surveillance actions must be reinforced in Brazil, technical support and safety training improved, focused on applicators and helpers, who are occupationally and environmentally exposed to pesticides. Agricultural practices of these groups with less pesticide use should receive incentive.


Assuntos
Depressão/induzido quimicamente , Fazendeiros , Cefaleia/induzido quimicamente , Exposição Ocupacional/estatística & dados numéricos , Praguicidas/envenenamento , Praguicidas/toxicidade , Envenenamento/epidemiologia , Doenças Respiratórias/induzido quimicamente , Taquicardia/induzido quimicamente , Adolescente , Adulto , Agricultura , Brasil/epidemiologia , Criança , Estudos Transversais , Depressão/epidemiologia , Família , Feminino , Cefaleia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/efeitos adversos , Prevalência , Doenças Respiratórias/diagnóstico , Doenças Respiratórias/epidemiologia , Taquicardia/epidemiologia , Adulto Jovem
13.
Nitric Oxide ; 104-105: 61-69, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-33038483

RESUMO

INTRODUCTION: Cardiovascular diseases are coupled to decreased nitric oxide (NO) bioavailability, and there is a constant search for novel and better NO-donors. Here we synthesized and characterized the cardiovascular effects of the new organic nitrate 2-nitrate-1,3-dioctanoxypropan (NDOP). METHODS: A combination of in vitro and in vivo experiments was performed in C57BL/6 mice and Wistar rats. Thus, the ability of NDOP in donating NO in a cell-free system and in vascular smooth muscles cells (VSMC) and its ability to induce vasorelaxation in aortic rings from mice were evaluated. In addition, changes in blood pressure and heart rate to different doses of NDOP were evaluated in conscious rats. Finally, acute pre-clinical toxicity to oral administration of NDOP was assessed in mice. RESULTS: In cell-free system, NDOP increased NO levels, which was dependent on xanthine oxidoreductase (XOR). NDOP also increased NO levels in VSMC, which was not influenced by endothelial NO synthase. Furthermore, incubation with the XOR inhibitor febuxostat blunted the vasorelaxation in aortic ring preparations. In conscious rats, NDOP elicited dose-dependent reduction in blood pressure accompanied with increased heart rate. In vessel preparations, NDOP (10-8-10-3 mol/L) induced endothelium-independent vasorelaxation, which was inhibited by the NO scavengers 2-phenyl-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide and hydroxocobalamin or by inhibition of soluble guanylyl cyclase using H- [1,2,4] oxadiazolo [4,3-a]quinoxalin-1-one. To investigate if NDOP acts through potassium channels, selective blockers were used. Inhibition of BKCa, Kv or KATP subtypes of potassium channels had no effect, but inhibition of inward-rectifier potassium channels (KIR) significantly reduced NDOP-mediated vasorelaxation. Lastly, NDOP showed low toxicity (LD50 ~5000 mg/kg). CONCLUSION: Bioactivation of NDOP involves functional XOR, and this new organic nitrate elicits vasorelaxation via NO-cGMP-PKG signaling and activation of KIR channels. Future studies should further characterize the underlying mechanism and evaluate the therapeutic benefits of chronic NDOP treatment in relevant cardiovascular disease models.


Assuntos
Doadores de Óxido Nítrico/farmacologia , Óxido Nítrico/metabolismo , Nitrocompostos/farmacologia , Canais de Potássio Corretores do Fluxo de Internalização/metabolismo , Vasodilatação/efeitos dos fármacos , Vasodilatadores/farmacologia , Animais , Pressão Sanguínea/efeitos dos fármacos , Inibidores Enzimáticos/farmacologia , Feminino , Masculino , Camundongos Endogâmicos C57BL , Doadores de Óxido Nítrico/toxicidade , Nitrocompostos/toxicidade , Oxidiazóis/farmacologia , Quinoxalinas/farmacologia , Ratos Wistar , Transdução de Sinais/efeitos dos fármacos , Guanilil Ciclase Solúvel/antagonistas & inibidores , Taquicardia/induzido quimicamente , Vasodilatadores/toxicidade , Xantina Desidrogenase/metabolismo
14.
Folia Med (Plovdiv) ; 62(3): 515-518, 2020 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-33009763

RESUMO

INTRODUCTION: A smokeless tobacco known as Maras powder (MP) is commonly consumed in the southern region of Turkey. To the extent of our knowledge, no previous study in literature has reported acute MP intoxication in children. AIM: Our aim was to determine the clinical effects and treatment strategies of MP poisoning in children.Materials and methods: We retrospectively reviewed the medical records of children <18 years of age with MP intoxication who were followed up in the Intensive Care Unit between January 2016 and April 2018 in our center. RESULTS: Forty-one patients (M/F= 25/16) were included in this study. The mean age was 13.2±22.4 months (age range: 7 to 30 months). The patients presented with vomiting (n=23, 56%), cough (n=17, 41.5%), loss of consciousness (n=11, 26.8%), respiratory distress (n=6, 14.6%), convulsion (n=7, 17%), cyanosis (n=1, 2.4%), and abdominal pain (n=1, 2.4%) following oral ingestion of the substance. On their physical examination all patients with convulsion were in a comatose state. Thirty-two patients (78%) had tachycardia; 15 patients (36.5%) had pharyngeal hyperemia; and three (7.3%) had hiccups. Although the female patients had a lesser rate of symptoms than male patients, the difference was not statistically significant. CONCLUSIONS: Our aim was to inform the doctors about the clinical picture that develops after taking this substance and contribute to the understanding of the treatment approach.


Assuntos
Envenenamento/epidemiologia , Tabaco sem Fumaça/envenenamento , Criança , Pré-Escolar , Tosse/induzido quimicamente , Feminino , Humanos , Lactente , Masculino , Envenenamento/complicações , Estudos Retrospectivos , Taquicardia/induzido quimicamente , Turquia , Vômito/induzido quimicamente
16.
J Equine Vet Sci ; 92: 103181, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32797773

RESUMO

A 26-year-old pony mare (ca. 180 kg bodyweight) was presented as an emergency because it had erroneously received 110 times its standard dose of pergolide (Prascend) per os approximately 4 hours earlier. Clinical examination initially was normal except tachycardia of 52 beats/min. The pony was treated symptomatically with paraffin oil and activated charcoal per nasogastric tube to prevent further systemic absorption and accelerate intestinal excretion of the pergolide. Furthermore, the pony received 400 mg of dopamine antagonist azaperone (Stresnil) intramuscularly (i.m.) followed by 80 mg every 6 hours twice i.m. and then 60 mg every 6 hours twice i.m. In addition, 40 mg verapamil (Verapamil-ratiopharm) was given every 4 hours per os for two days, followed by 40 mg every 6 hours for another 5 days. The pony was closely monitored clinically. It remained bright and alert with heart rate returning to normal within one day. The only abnormalities noticed 24 hours after ingestion of the pergolide overdose were a decreased appetite and anxiety, possibly a dopaminergic central nervous effect. Over the next days, appetite returned and anxiety disappeared. Overdosing pergolide is considered very rare and to the authors' knowledge this is the first report with a severe overdose of pergolide (Prascend). As accidental drug overdosing is a common error in medicine, it is important to know about possible side effects and how to react in cases like this.


Assuntos
Doenças dos Cavalos , Pergolida , Animais , Apetite , Feminino , Frequência Cardíaca , Cavalos , Taquicardia/induzido quimicamente , Taquicardia/veterinária
17.
Pediatr Pulmonol ; 55(9): 2272-2282, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32478966

RESUMO

BACKGROUND: Nonsteroidal anti-inflammatory drugs, such as selective phosphodiesterase type 4 (PDE4) inhibitors have potential anti-inflammatory and respiratory smooth muscle relaxation effects. This study aimed to investigate the pathophysiological effects of an intravenous PDE4 inhibitor (rolipram) and surfactant lavage (SL) in a newborn piglet model of meconium aspiration syndrome (MAS). METHODS: MAS was induced in 25 newborn piglets, which were randomly divided into control and four SL treatment groups administered with different doses of intravenous rolipram (0, 0.1, 0.5, and 1 mg/kg). Cardiopulmonary variables were monitored and recorded. The experimental time was 4 hours. Serial blood was drawn for blood gas and biomarker analyses. Lung tissue was examined for histological analysis. RESULTS: All SL-treated groups revealed improved oxygenation during the 4-hour experiments and had significantly lower peak inspiratory pressure levels than the control group at the end of experiments. All SL plus rolipram-treated groups exhibited significantly higher lung compliance than the control group. However, the animals receiving high-dose (0.5 and 1.0 mg/kg) rolipram demonstrated significantly elevated heart rates. Lung histology of the nondependent sites revealed significantly lower lung injury scores in all SL-treated groups compared with that in the control group, but there were no differences among the rolipram-treated groups. CONCLUSIONS: In addition to SL, intravenous PDE4 inhibitors may further improve lung compliance in treating MAS; however, it is necessary to consider cardiovascular adverse effects, primarily tachycardia. Further investigations are required before the clinical application of intravenous PDE4 inhibitor as an anti-inflammatory agent to treat severe MAS.


Assuntos
Lavagem Broncoalveolar , Síndrome de Aspiração de Mecônio/terapia , Inibidores da Fosfodiesterase 4/administração & dosagem , Rolipram/administração & dosagem , Tensoativos/administração & dosagem , Administração Intravenosa , Animais , Animais Recém-Nascidos , Terapia Combinada , Humanos , Pulmão/efeitos dos fármacos , Pulmão/patologia , Pulmão/fisiopatologia , Complacência Pulmonar/efeitos dos fármacos , Mecônio , Síndrome de Aspiração de Mecônio/patologia , Síndrome de Aspiração de Mecônio/fisiopatologia , Inibidores da Fosfodiesterase 4/efeitos adversos , Rolipram/efeitos adversos , Tensoativos/efeitos adversos , Suínos , Taquicardia/induzido quimicamente , Taquicardia/patologia , Taquicardia/fisiopatologia
18.
Eur J Obstet Gynecol Reprod Biol ; 249: 54-58, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32361173

RESUMO

OBJECTIVES: To investigate if tachysystole was associated with an increased risk of cesarean section or unfavorable maternal or neonatal outcomes following induction of labor by misoprostol vaginal inserts. STUDY DESIGN: We conducted a retrospective cohort study of 446 women over 37 weeks of gestation admitted for labor induction by misoprostol vaginal inserts between May 2016 and May 2017. Fetal heart rate and uterine activity tracings were assessed for tachysystole, defined as ≥ 6 contractions per 10 min, averaged over a 30-minute window. Univariate analysis was performed by using t-test and Chi-square, comparing demographics, pregnancy characteristics, intrapartum monitoring, mode of delivery, neonatal outcomes (Apgar score < 7 at 5 min, umbilical cord artery pH < 7.10, neonatal intensive care unit admission) and maternal outcomes, with regard to the presence of tachysystole. The association between tachysystole and cesarean section was evaluated after adjusting for potential confounders by a modified Poisson regression model, expressed as an adjusted risk ratio and 95 % confidence intervals. RESULTS: A total of 140 women (31.4 %) presented with tachysystole. The median duration of tachysystole was 2 h 12 min. The rate of cesarean section was 25.0 % (N = 35) among patients with tachysystole and 19.6 % (N = 60) for those without tachysystole. Presence of tachysystole during induction of labor with misoprostol vaginal inserts was not associated with cesarean section (adjusted risk ratio,1.0; 95 % confidence interval, 0.7-1.4). Neonatal and maternal outcomes were similar between mothers who did and did not experience tachysystole. CONCLUSIONS: This study illustrates that tachysystole is not associated with an increased risk of cesarean section after induction of labor by misoprostol vaginal inserts. The impact of excessive uterine activity on the fetal wellbeing defined by the frequency of uterine contraction alone is probably insufficient. Further research on the development of accurate measures of uterine contractility is necessary to better understand its effect on fetal well-being.


Assuntos
Cesárea/estatística & dados numéricos , Trabalho de Parto Induzido/efeitos adversos , Misoprostol/efeitos adversos , Ocitócicos/efeitos adversos , Taquicardia/induzido quimicamente , Administração Intravaginal , Adulto , Feminino , Frequência Cardíaca Fetal/efeitos dos fármacos , Humanos , Recém-Nascido , Trabalho de Parto/efeitos dos fármacos , Distribuição de Poisson , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Fatores de Risco , Sístole/efeitos dos fármacos , Taquicardia/embriologia , Contração Uterina/efeitos dos fármacos
19.
Cochrane Database Syst Rev ; 4: CD004198, 2020 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-32251534

RESUMO

BACKGROUND: Sickle cell disease comprises a group of genetic haemoglobin disorders. The predominant symptom associated with sickle cell disease is pain resulting from the occlusion of small blood vessels by abnormally 'sickle-shaped' red blood cells. There are other complications, including chronic organ damage and prolonged painful erection of the penis, known as priapism. Severity of sickle cell disease is variable, and treatment is usually symptomatic. Priapism affects up to half of all men with sickle cell disease, however, there is no consistency in treatment. We therefore need to know the best way of treating this complication in order to offer an effective interventional approach to all affected individuals. This is an update of a previously published review. OBJECTIVES: To assess the benefits and risks of different treatments for stuttering (repeated short episodes) and fulminant (lasting for six hours or more) priapism in sickle cell disease. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register, which comprises references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. We also searched trial registries. Date of the most recent search of the Group's Haemoglobinopathies Trials Register: 09 September 2019. Date of most recent search of trial registries and of Embase: 01 October 2019. SELECTION CRITERIA: All randomised or quasi-randomised controlled trials comparing non-surgical or surgical treatment with placebo or no treatment, or with another intervention for stuttering or fulminant priapism. DATA COLLECTION AND ANALYSIS: The authors independently extracted data and assessed the risk of bias of the trials. MAIN RESULTS: Three trials with 102 participants were identified and met the criteria for inclusion in this review. These trials compared stilboestrol to placebo, sildenafil to placebo and a four-arm trial which compared ephedrine or etilefrine to placebo and ranged in duration from two weeks to six months. All of the trials were conducted in an outpatient setting in Jamaica, Nigeria and the UK. None of the trials measured our first primary outcome, detumescence. However, all three trials reported on the reduction in frequency of stuttering priapism, our second primary outcome; and from the evidence included in this review, we are uncertain whether stilboestrol, etilefrine or ephedrine reduce the frequency of stuttering priapism as the certainty of the evidence has been assessed as very low. Additionally, we conclude that sildenafil may make little or no difference (low-certainty evidence). Two trials reported on immediate side effects and we are uncertain whether etilefrine or ephedrine reduce the occurrence of these (very low-certainty of evidence) and also conclude that sildenafil may make little or no difference in side effects (low-quality evidence). Given that all of the trials were at risk of bias and all had low participant numbers, we considered the certainty of the evidence to be low to very low. AUTHORS' CONCLUSIONS: There is a lack of evidence for the benefits or risks of the different treatments for both stuttering and fulminant priapism in sickle cell disease. This systematic review has clearly identified the need for well-designed, adequately-powered, multicentre randomised controlled trials assessing the effectiveness of specific interventions for priapism in sickle cell disease.


Assuntos
Anemia Falciforme/complicações , Dietilestilbestrol/uso terapêutico , Estrogênios não Esteroides/uso terapêutico , Priapismo/tratamento farmacológico , Vasoconstritores/uso terapêutico , Adrenérgicos/efeitos adversos , Adrenérgicos/uso terapêutico , Efedrina/efeitos adversos , Efedrina/uso terapêutico , Etilefrina/efeitos adversos , Etilefrina/uso terapêutico , Humanos , Masculino , Priapismo/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Citrato de Sildenafila/uso terapêutico , Taquicardia/induzido quimicamente , Vasoconstritores/efeitos adversos , Adulto Jovem
20.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(2): 243-244, 2020 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-32275016

RESUMO

Norepinephrine (NE) can raise blood pressure and speed up heart rate. However, because its effect of raising heart rate is less than that of reflex reduction of heart rate caused by the increase of blood pressure, NE causes more heart rate decrease in patients. A case of tachyarrhythmia caused by low dose NE was admitted to department of intensive care unit (ICU) of Shijiazhuang Third Hospital. The heart rate of the patient increased with the elevation of NE application dose. A variety of antiarrhythmic drugs was invalid. The related examination was prescribed to eliminate the cause of arrhythmia caused by the disorder of electrolysis and thyroid function, and found that heart rate decreased as the dose of NE tapered. After NE was stopped, the patient recovered sinus rhythm. During one month of follow-up, the patient's heart rhythm was normal. Therefore, the occurrence of tachyarrhythmia is related to NE.


Assuntos
Norepinefrina/efeitos adversos , Taquicardia/induzido quimicamente , Pressão Sanguínea , Frequência Cardíaca , Humanos , Norepinefrina/administração & dosagem , Taquicardia/diagnóstico
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