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1.
Oral Maxillofac Surg Clin North Am ; 34(1): 49-59, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34598856

RESUMO

Temporomandibular joint disorder is defined by pain and/or loss of function of the temporomandibular joint and its associated muscles and structures. Treatments include noninvasive pharmacologic therapies, minimally invasive muscular and articular injections, and surgery. Conservative therapies include nonsteroidal anti-inflammatory drugs, muscle relaxants, benzodiazepines, antidepressants, and anticonvulsants. Minimally invasive injections include botulinum toxin, corticosteroids, platelet-rich plasma, hyaluronic acid, and prolotherapy with hypertonic glucose. With many pharmacologic treatment options and modalities available to the oral and maxillofacial surgeon, mild to moderate temporomandibular joint disorder can be managed safely and effectively to improve symptoms of pain and function of the temporomandibular joint.


Assuntos
Transtornos da Articulação Temporomandibular , Anticonvulsivantes/uso terapêutico , Humanos , Ácido Hialurônico/uso terapêutico , Injeções Intra-Articulares , Articulação Temporomandibular , Transtornos da Articulação Temporomandibular/tratamento farmacológico
2.
Oral Maxillofac Surg Clin North Am ; 34(1): 169-177, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34728145

RESUMO

This article focuses on the antimicrobial therapy of head and neck infections from odontogenic origin. Odontogenic infections are among the most common infections of the oral cavity. They are sourced primarily from dental caries and periodontal disease (gingivitis and periodontitis). Many odontogenic infections are self-limiting and may drain spontaneously. However, these infections may drain into the anatomic spaces adjacent to the oral cavity and spread along the contiguous facial planes, leading to more serious infections. Antibiotics are an important aspect of care of the patient with an acute odontogenic infection. Antibiotics are not a substitute for definitive surgical management.


Assuntos
Cárie Dentária , Doenças Periodontais , Cirurgia Bucal , Antibacterianos/uso terapêutico , Cárie Dentária/tratamento farmacológico , Drenagem , Humanos , Doenças Periodontais/tratamento farmacológico , Doenças Periodontais/cirurgia
3.
Urol Clin North Am ; 49(1): 11-22, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34776045

RESUMO

BPH is a common disease in aging men which impacts quality of life. With advancing age expectation coupled with the rising demand for BPH therapy, new technologies have been developed that target rapid recovery and symptom relief, low complication rates, and the ability to perform the procedure in an outpatient setting with local anesthesia. MIST technologies have fostered BPH medical care with ejaculation preservation. Techniques and outcomes for BPH technologies including Aquablation, Rezum, UroLift, iTind, Optilume BPH, XFLO, Zenflow, and Butterfly are reviewed and evaluated. Given the novelty of these technologies, long-term data are required to assess safety and efficacy.


Assuntos
Técnicas de Ablação , Hiperplasia Prostática/cirurgia , Próteses e Implantes , Cateteres Urinários , Técnicas de Ablação/efeitos adversos , Ligas , Antineoplásicos Fitogênicos/uso terapêutico , Dilatação/instrumentação , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Paclitaxel/uso terapêutico , Próteses e Implantes/efeitos adversos , Procedimentos Cirúrgicos Robóticos , Vapor , Cateteres Urinários/efeitos adversos
4.
Urol Clin North Am ; 49(1): 175-184, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34776050

RESUMO

Over the past decade, there have been several advancements in the technologies available to treatment erectile dysfunction and Peyronie's disease. Vacuum erection devices, penile traction devices, low-intensity extracorporeal shockwave therapy, and penile prosthesis surgery have evolved and are changing the way we treat men's health. Although significant improvements have been made, further work is needed to standardize treatment, create universal algorithms for technological applications, and simply their use.


Assuntos
Disfunção Erétil/terapia , Induração Peniana/terapia , Prótese de Pênis , Terapia Combinada , Tratamento por Ondas de Choque Extracorpóreas , Humanos , Masculino , Colagenase Microbiana/uso terapêutico , Implante Peniano , Tração , Vácuo
5.
Emerg Med Clin North Am ; 40(1): 1-17, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34782082

RESUMO

Allergic reactions and anaphylaxis occur on a severity continuum from mild and self-limited to potentially life-threatening or fatal reactions. Anaphylaxis is typically a multiorgan phenomenon involving a broad range of effector cells and mediators. Emergency department visits for anaphylaxis are increasing, especially among children. There is a broad differential diagnosis for anaphylaxis, and the diagnosis of anaphylaxis can be aided by the use of the National Institutes of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network clinical diagnostic criteria. Risk factors for severe anaphylaxis include older age, delayed epinephrine administration, and cardiopulmonary comorbidities.


Assuntos
Anafilaxia/fisiopatologia , Hipersensibilidade/fisiopatologia , Anafilaxia/diagnóstico , Epinefrina/uso terapêutico , Humanos , Hipersensibilidade/diagnóstico , Fatores de Risco
6.
Emerg Med Clin North Am ; 40(1): 19-32, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34782088

RESUMO

Anaphylaxis is a potentially life-threatening, multisystem allergic reaction that can cause airway, breathing, or circulatory compromise. Intramuscular epinephrine is the immediate treatment of all patients. Intravenous epinephrine should be used in patients in shock, either as a bolus or infusion, along with fluid resuscitation. Airway obstruction must be recognized, and early intubation may be necessary. For shock that is refractory to epinephrine, additional vasopressors may be needed. Disposition depends on patient presentation and response to treatment. Mandatory observation periods are not necessary, because biphasic reactions are difficult to predict and may occur outside of typical observation periods.


Assuntos
Anafilaxia/terapia , Manuseio das Vias Aéreas/métodos , Anafilaxia/classificação , Anafilaxia/fisiopatologia , Medicina de Emergência/métodos , Epinefrina/administração & dosagem , Epinefrina/uso terapêutico , Hidratação , Humanos , Fatores de Risco , Vasoconstritores/administração & dosagem , Vasoconstritores/uso terapêutico
7.
Emerg Med Clin North Am ; 40(1): 33-37, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34782089

RESUMO

After treating the acute anaphylactic reaction, the clinician's next task is to prevent a recurrence. The patient should be observed in the ED. How long this observation period should last depends on their clinical course, risk factors, and social support. All patients should be discharged with a prescription for 2 epinephrine autoinjectors and counseled on appropriate use. The patient should also receive education on the signs and symptoms of anaphylaxis and avoiding triggers. The patient should follow-up with an allergy specialist who can confirm triggers and provide immunotherapy as indicated.


Assuntos
Anafilaxia/terapia , Alta do Paciente , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/tendências , Epinefrina/administração & dosagem , Epinefrina/uso terapêutico , Humanos , Fatores de Risco
8.
Emerg Med Clin North Am ; 40(1): 57-67, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34782091

RESUMO

Food allergies are a common and serious cause of illness, accounting for an increasing number of emergency department visits annually. Although definite diagnosis lays outside of an emergency department visit, the clinical management of the most serious food allergies highlights emergency care. The staple of acute care remains epinephrine in association with antihistamines and steroids. The greatest threat remains undertreatment for this group of disorders and underutilization of epinephrine. Those who have been treated for a food allergy need a follow-up allergist evaluation, guidance of food avoidance, and avoidance of foods with cross-sensitivities as well as ready access to epinephrine.


Assuntos
Hipersensibilidade Alimentar/terapia , Medicina de Emergência/métodos , Serviço Hospitalar de Emergência/organização & administração , Epinefrina/uso terapêutico , Hipersensibilidade Alimentar/complicações , Hipersensibilidade Alimentar/epidemiologia , Humanos
9.
Crit Care Clin ; 38(1): 69-87, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34794632

RESUMO

Diagnostic stewardship encompasses the entire diagnosis-to-treatment paradigm in the intensive care unit (ICU). Initially born of the antimicrobial stewardship movement, contemporary diagnostic stewardship aims to promote timely and appropriate diagnostic testing that directly links to management decisions. In the stewardship framework, excessive diagnostic testing in low probability cases is discouraged due to its tendency to generate false-positive results, which have their own downstream consequences. Though the evidence basis for diagnostic stewardship initiatives in the ICU is nascent and largely limited to retrospective analyses, available literature generally suggests that these initiatives are safe, feasible, and associated with similar patient outcomes. As diagnostic testing of critically ill patients becomes increasingly sophisticated in the ensuing decade, a stewardship mindset will aid bedside clinicians in interpreting and incorporating new diagnostic strategies in the ICU.


Assuntos
Gestão de Antimicrobianos , Antibacterianos/uso terapêutico , Estado Terminal , Humanos , Unidades de Terapia Intensiva , Estudos Retrospectivos
11.
J Hazard Mater ; 422: 126785, 2022 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-34403941

RESUMO

The development of highly efficient photonic nanomaterials with synergistic biological effects is critical and challenging task for public hygiene health well-being and has attracted extensive interest. In this study, a type of near-infrared (NIR) driven, virus-like heterojunction was first developed for synergistic biological application. The Ag-coated Bi2CO5 nanomaterial (BOCO@Ag) demonstrated good biocompatibility, low cytotoxicity, high antibacterial activity and excellent light utilization stability. The synthesized BOCO@Ag performed a potential high photothermal conversion (efficiency~46.81%) to generate high temperatures when irradiated with near-infrared light illumination. As expected, compared to single Ag+ disinfection, BOCO@Ag can exhibit better antibacterial performance when combined with photothermal energy and released Ag+ . These results suggest that BOCO@Ag can be a promising photo-activate antimicrobial candidate and provide security for humans health and the environment treatment.


Assuntos
Antibacterianos , Nanosferas , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Desinfecção , Humanos , Raios Infravermelhos , Prata
12.
J Med Virol ; 94(1): 384-387, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34406670

RESUMO

The antiviral remdesivir has been shown to decrease the length of hospital stay in coronavirus disease 2019 (COVID-19) patients requiring supplemental oxygen. However many patients decompensate despite being treated with remdesivir. To identify potential prognostic factors in remdesivir-treated patients, we performed a retrospective cohort study of patients hospitalized at NewYork-Presbyterian Hospital/Weill Cornell Medical Center between March 23, 2020 and May 27, 2020. We identified 55 patients who were treated with remdesivir for COVID-19 and analyzed inflammatory markers and clinical outcomes. C-reactive protein (CRP), d-dimer, and lactate dehydrogenase levels were significantly higher in patients who progressed to intubation or death by 14 days compared to those who remained stable. CRP levels decreased significantly after remdesivir administration in patients who remained nonintubated over the study period. To our knowledge, this is the largest study to date examining inflammatory markers before and after remdesivir administration. Our findings support further investigation into COVID-19 treatment strategies that modify the inflammatory response.


Assuntos
Monofosfato de Adenosina/análogos & derivados , Alanina/análogos & derivados , Antivirais/uso terapêutico , COVID-19/tratamento farmacológico , COVID-19/mortalidade , SARS-CoV-2/efeitos dos fármacos , Monofosfato de Adenosina/uso terapêutico , Idoso , Alanina/uso terapêutico , Biomarcadores/sangue , Proteína C-Reativa/análise , COVID-19/patologia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Inflamação/tratamento farmacológico , L-Lactato Desidrogenase/sangue , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , SARS-CoV-2/imunologia
13.
J Med Virol ; 94(1): 63-81, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34468995

RESUMO

Although significant research has been done to find effective drugs against coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), no definite effective drug exists. Thus, research has now shifted towards immunomodulatory agents other than antivirals. In this review, we aim to describe the latest findings on the role of type I interferon (IFN)-mediated innate antiviral response against SARS-CoV-2 and discuss the use of IFNs as a medication for COVID-19. A growing body of evidence has indicated a promoting active but delayed IFNs response to SARS-CoV-2 and Middle East respiratory syndrome coronavirus in infected bronchial epithelial cells. Studies have demonstrated that IFNs' administration before the viral peak and the inflammatory phase of disease could offer a highly protective effect. However, IFNs' treatment during the inflammatory and severe stages of the disease causes immunopathology and long-lasting harm for patients. Therefore, it is critical to note the best time window for IFNs' administration. Further investigation of the clinical effectiveness of interferon for patients with mild to severe COVID-19 and its optimal timing and route of administration can be beneficial in finding a safe and effective antiviral therapy for the COVID-19 disease.


Assuntos
Antivirais/uso terapêutico , COVID-19/tratamento farmacológico , Interferon Tipo I/uso terapêutico , SARS-CoV-2/efeitos dos fármacos , Humanos , Imunidade Inata/imunologia , Fatores Imunológicos/uso terapêutico , Imunomodulação/efeitos dos fármacos
14.
J Med Virol ; 94(1): 291-297, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34491575

RESUMO

Due to current advances and growing experience in the management of coronavirus Disease 2019 (COVID-19), the outcome of COVID-19 patients with severe/critical illness would be expected to be better in the second wave compared with the first wave. As our hospitalization criteria changed in the second wave, we aimed to investigate whether a favorable outcome occurred in hospitalized COVID-19 patients with only severe/critical illness. Among 642 laboratory-confirmed hospitalized COVID-19 patients in the first wave and 1121 in the second wave, those who met World Health Organization (WHO) definitions for severe or critical illness on admission or during follow-up were surveyed. Data on demographics, comorbidities, C-reactive protein (CRP) levels on admission, and outcomes were obtained from an electronic hospital database. Univariate analysis was performed to compare the characteristics of patients in the first and second waves. There were 228 (35.5%) patients with severe/critical illness in the first wave and 681 (60.7%) in the second wave. Both groups were similar in terms of age, gender, and comorbidities, other than chronic kidney disease. Median serum CRP levels were significantly higher in patients in the second wave compared with those in the first wave [109 mg/L (interquartile range [IQR]: 65-157) vs. 87 mg/L (IQR: 39-140); p < 0.001]. However, intensive care unit admission and mortality rates were similar among the waves. Even though a lower mortality rate in the second wave has been reported in previous studies, including all hospitalized COVID-19 patients, we found similar demographics and outcomes among hospitalized COVID-19 patients with severe/critical illness in the first and second wave.


Assuntos
COVID-19/tratamento farmacológico , COVID-19/mortalidade , Cuidados Críticos/estatística & dados numéricos , Índice de Gravidade de Doença , Idoso , Amidas/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Azitromicina/uso terapêutico , Proteína C-Reativa/análise , COVID-19/epidemiologia , COVID-19/patologia , Comorbidade , Combinação de Medicamentos , Enoxaparina/uso terapêutico , Feminino , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Hidroxicloroquina/uso terapêutico , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Lopinavir/uso terapêutico , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Pirazinas/uso terapêutico , Estudos Retrospectivos , Ritonavir/uso terapêutico , SARS-CoV-2 , Resultado do Tratamento , Turquia/epidemiologia
15.
Handb Exp Pharmacol ; 268: 117-133, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34247278

RESUMO

Wheals and angioedema are the signature signs of urticaria, and itch is the key symptom. Urticaria, in most patients, is acute and resolves within days (acute urticaria, AU). Chronic urticaria (CU) can be of long duration and results not only in severely impaired quality of life but also has a socioeconomic impact due to work productivity impairment. In some patients with CU, the wheals and angioedema are induced exclusively by defined and definite triggers (chronic inducible urticaria, CIndU). In most patients with CU, wheals and angioedema develop unprompted, spontaneously (chronic spontaneous urticaria, CSU). The management of CU aims for the complete control and absence of its signs and symptoms. This is achieved, in most patients, by prophylactic treatment until spontaneous remission occurs. Modern, second-generation H1-antihistamines are the first-line therapy, with the option of updosing to fourfold, and omalizumab is used when this fails.


Assuntos
Antialérgicos , Urticária Crônica , Urticária , Antialérgicos/uso terapêutico , Doença Crônica , Humanos , Omalizumab/uso terapêutico , Qualidade de Vida , Urticária/diagnóstico , Urticária/tratamento farmacológico , Urticária/etiologia
16.
Pain Manag ; 12(1): 45-57, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34284613

RESUMO

Aim: HTX-011 (ZYNRELEF™) is an extended-release, dual-acting local anesthetic containing bupivacaine and meloxicam. In bunionectomy and herniorrhaphy studies, HTX-011 resulted in less postoperative pain and less opioid consumption versus bupivacaine HCl. Here we evaluate HTX-011 in patients aged ≥65 years. Materials & methods: Patients received placebo, bupivacaine HCl or HTX-011 following surgery. End points included pain intensity, total opioid consumption, opioid-free patients and safety. Results: HTX-011-treated patients reported lower postoperative pain through 72 h versus bupivacaine HCl and placebo. Elderly patients administered HTX-011 used fewer opioids versus bupivacaine HCl, and a greater proportion remained opioid-free through 72 h. HTX-011 was well tolerated with a safety profile similar to bupivacaine HCl and placebo. Conclusion: HTX-011 maintained effectiveness and was well tolerated in elderly patients. Clinical Trial registration numbers: NCT03295721 and NCT03237481.


Assuntos
Analgésicos Opioides , Dor Pós-Operatória , Idoso , Analgésicos Opioides/uso terapêutico , Anestésicos Locais , Bupivacaína , Método Duplo-Cego , Humanos , Dor Pós-Operatória/tratamento farmacológico
17.
Pain Manag ; 12(1): 105-116, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34551582

RESUMO

Total knee arthroplasty (TKA) is a common orthopedic surgery performed with a projected 3.5 million procedures to be done by 2030. Current postoperative pain management for TKA is insufficient, as it results in extensive opioid consumption and functional decline postoperatively. This study identifies the best practices for postoperative TKA pain management through a literature review of the last three years. Studies utilizing interventional techniques (local infiltration analgesia, nerve blocks) and pharmacologic options were reviewed on PubMed, Embase, Ovid Medline and Scopus. Primary outcomes analyzed were the effect of different analgesic approaches on pain reduction, opioid use reduction and improvements in functional mobility or quadriceps strength postoperatively. Additionally, this paper explores the use of cooled radiofrequency ablation, a minimally invasive therapy, for preoperative and postoperative TKA pain management.


Assuntos
Analgesia , Artroplastia do Joelho , Bloqueio Nervoso , Analgésicos Opioides/uso terapêutico , Artroplastia do Joelho/efeitos adversos , Humanos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle
18.
Vet Clin North Am Exot Anim Pract ; 25(1): 13-29, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34823688

RESUMO

Veterinarians often need to sedate or anesthetize fish to perform physical examinations or other diagnostic procedures. Sedation may also be required to transport fish. Painful procedures require complete anesthesia with appropriate antinociceptive agents. Regulations and withdrawal times apply to food animal species in many countries. Specific protocols are therefore warranted in commercial fish versus ornamentals. Tonic immobility of elasmobranchs and electric anesthesia should never be used to perform painful procedures. Anesthetic monitoring in fish remains challenging. This review summarizes ornamental fish anesthesia and discusses techniques used in the commercial fish industry and in field conditions.


Assuntos
Anestesia , Médicos Veterinários , Analgésicos/uso terapêutico , Anestesia/veterinária , Animais , Peixes , Humanos , Dor/tratamento farmacológico , Dor/veterinária
19.
Cardiol Clin ; 40(1): 13-27, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34809914

RESUMO

Pulmonary arterial hypertension is a rare disease characterized by pulmonary microvasculature remodeling leading to right ventricular failure and death. Medical management of pulmonary hypertension has grown increasingly complex as more therapeutic agents have been developed. Evolving treatment strategies leveraging the endothelin, nitric oxide, and prostacyclin pathways lead to improved exercise capacity and outcomes in patients; however, significant opportunities for advancement remain.


Assuntos
Insuficiência Cardíaca , Hipertensão Pulmonar , Hipertensão Arterial Pulmonar , Anti-Hipertensivos/uso terapêutico , Humanos , Hipertensão Pulmonar/tratamento farmacológico , Hipertensão Pulmonar/epidemiologia
20.
Breast Dis ; 41(1): 1-3, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34219707

RESUMO

During the first hit of SARS-COVID pandemic, an important reorganization of Healthcare Services has been done, and new protocols and pathways to protect frail patients like oncological patients were designed. The second hit of pandemic had stressed these new pathways and suggests to health-workers some improvements for safer management of patents.We reported our experience in organizing the clinical pathway of neoadjuvant therapy candidate patients based on the execution of sentinel lympho-node biopsy and the placement of implantable venous access port in the same access to operating room before neoadjuvant chemotherapy suggesting a possible organizational model. In the period October-December 2020 we have included in this new type of path twelve patients and we have not registered any cases of COVID among the patients included. We think this new path, adopted amid the second hit, will be useful for all Breast Units that are facing the challenge of guaranteeing the highest standards of care in a historical moment where the health emergency occupies the efforts of health workers and the economic resources of health systems.


Assuntos
Antineoplásicos/administração & dosagem , Neoplasias da Mama/tratamento farmacológico , COVID-19/prevenção & controle , Cateterismo Venoso Central/métodos , Controle de Infecções/métodos , Segurança do Paciente , Biópsia de Linfonodo Sentinela/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Cateterismo Venoso Central/instrumentação , Cateterismo Venoso Central/normas , Cateteres Venosos Centrais , Quimioterapia Adjuvante , Procedimentos Clínicos , Feminino , Humanos , Controle de Infecções/normas , Mastectomia , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Biópsia de Linfonodo Sentinela/normas
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