Assuntos
Humanos , Criança , Adolescente , Antitussígenos/efeitos adversos , Descongestionantes Nasais/efeitos adversos , Resfriado Comum/tratamento farmacológico , Tosse/tratamento farmacológico , Antitussígenos/uso terapêutico , Simpatomiméticos/efeitos adversos , Simpatomiméticos/uso terapêutico , Descongestionantes Nasais/uso terapêutico , Combinação de Medicamentos , Antagonistas dos Receptores Histamínicos/efeitos adversos , Antagonistas dos Receptores Histamínicos/uso terapêutico , Analgésicos/efeitos adversos , Analgésicos/uso terapêuticoRESUMO
BACKGROUND: In 2011 a list of 20 drugs linked to drug-induced Tako-Tsubo cardiomyopathy (TCM) was published. Thus, the objectives were both to identify cases of drug-induced TCM, and update the 2011 list of drugs as possible triggers of this cardiomyopathy. METHOD: As the 2011 report of drug-induced TCM, case reports of drug-induced TCM were identified by a comprehensive search in Medline/PubMed database. From December 2010 to March 2015 search terms were Takotsubo cardiomyopathy, Takotsubo cardiomyopathy, stress cardiomyopathy, transient-left-ventricular ballooning syndrome, ampulla cardiomyopathy, apical ballooning syndrome, OR broken heart syndrome; together with "iatrogenic", "drug-induced", OR "induced by". Publications limited to English, Spanish, and French, in humans, and with full texts were retrieved. Articles that recognized any drug as a possible trigger of TCM were selected. RESULTS: Overall, 405 different references were retrieved and 67 were selected (62 case reports and 5 case series) involving 78 patient cases with TCM possibly associated to drugs were reviewed. At total of 44 drugs were recognized as possible drug-induced TCM, mainly with sympathetic effect, and 37 (84.1%) were different to those 20 identified in the 2011 review; therefore, a list of 57 drugs associated to TCM was obtained. CONCLUSION: There are new case reports that linked drug-use with the development of TCM. The list of 57 drugs obtained is principally integrated by drugs that generate sympathetic overstimulation. Consequently, the recommendation "drug-induced TCM would be considered in patients with TCM, particularly those in which no clear emotional or stress trigger could be identified" is endorsed.
Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Simpatomiméticos/efeitos adversos , Cardiomiopatia de Takotsubo/induzido quimicamente , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/fisiopatologia , HumanosRESUMO
BACKGROUND: Inadequate nutrition support is common among critically ill patients, and identification of risk factors for such inadequacy might help in improving nutrition support. OBJECTIVE: To determine how often daily calorie goals are met and the factors responsible for inadequate nutrition support. Methods A single-center prospective cohort study. Each patient's demographic and clinical characteristics, the need for ventilatory support, the use and dosage of medications, the number of nursing staff per bed, the time elapsed from admission to the intensive care unit until the effective start of enteral feeding, and the causes for nonadministration were recorded. Achievement of daily calorie goals was determined and correlated with risk factors. RESULTS: A total of 262 daily evaluations were done in 40 patients. Daily calorie goal was achieved in only 46.2% of the evaluations (n = 121), with a mean of 74.8% of the prescribed volume of enteral nutrition infused daily. Risk factors for inadequate nutrition support were the use of midazolam (odds ratio, 1.58; 95% CI, 1.18-2.11) and fewer nursing professionals per bed (odds ratio, 2.56; 95% CI, 1.43-4.57). Conclusion Achievement of daily calorie goals was inadequate, and the main factors associated with this failure were the use and dosage of midazolam and the number of nurses available.
Assuntos
Estado Terminal/enfermagem , Unidades de Terapia Intensiva , Midazolam/efeitos adversos , Recursos Humanos de Enfermagem Hospitalar/provisão & distribuição , Apoio Nutricional/normas , APACHE , Idoso , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Comorbidade , Estado Terminal/terapia , Ingestão de Energia , Nutrição Enteral/métodos , Nutrição Enteral/normas , Nutrição Enteral/estatística & dados numéricos , Feminino , Fentanila/efeitos adversos , Fentanila/uso terapêutico , Humanos , Hipnóticos e Sedativos/efeitos adversos , Hipnóticos e Sedativos/uso terapêutico , Unidades de Terapia Intensiva/normas , Unidades de Terapia Intensiva/estatística & dados numéricos , Modelos Logísticos , Masculino , Midazolam/uso terapêutico , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem Hospitalar/normas , Apoio Nutricional/métodos , Apoio Nutricional/estatística & dados numéricos , Fenilpropanolamina/efeitos adversos , Fenilpropanolamina/uso terapêutico , Estudos Prospectivos , Simpatomiméticos/efeitos adversos , Simpatomiméticos/uso terapêutico , Tramadol/efeitos adversos , Tramadol/uso terapêutico , Recursos Humanos , Carga de Trabalho/normas , Carga de Trabalho/estatística & dados numéricosRESUMO
BACKGROUND: Substance abuse is a serious health concern. This report presents the case of a 22-year-old Brazilian man with a history of mephentermine use who fulfils all the criteria for chemical dependence listed by ICD-10. Mephentermine is a sympathomimetic agent derived from methamphetamine which, in Brazil, is restricted to veterinary use. CASE DESCRIPTION: The subject used the substance at a high dose (120 mg) to improve his physical performance while working out at a gym. His symptoms included anorexia and insomnia. After days of intense activity, he felt fatigue and soreness. A physical examination revealed scars on both forearms from the injections and a psychological examination revealed moderate speech and motor agitation. CONCLUSIONS: Cases such as this may be common among the general public. They should have some bearing upon medical practice and public health policies involving drugs.
Assuntos
Transtornos Relacionados ao Uso de Anfetaminas/complicações , Mefentermina/efeitos adversos , Agitação Psicomotora/etiologia , Simpatomiméticos/efeitos adversos , Adulto , Animais , Anorexia/induzido quimicamente , Brasil , Depressão/induzido quimicamente , Fadiga/induzido quimicamente , Política de Saúde , Humanos , Masculino , Mefentermina/farmacologia , Distúrbios do Início e da Manutenção do Sono/induzido quimicamente , Simpatomiméticos/farmacologia , Adulto JovemRESUMO
INTRODUCTION: Nonaneurysmal subarachnoid hemorrhage (SAH) accounts for 15% to 20% of all the cases of SAH. Its prognosis may vary from complete recovery to different and serious complications. We describe a series of cases with nonaneurysmal SAHs, their clinical and tomographic characteristics and causes as well as long term prognosis. PATIENTS AND METHODS: 50 patients diagnosed of SAH and two negative brain angiographies for aneurysm were followed-up for an average period of 62 months. The demographic data of importance, vascular risk factors, were recorded. They were evaluated during the acute phase with the Hunt and Hess clinical scale and Fisher topographic scale. The distribution of the hemorrhage was listed as absent, perimesencephalic, focal, ventricular or diffuse. Presence of rebleeding, death and the functional course, measured by the Rankin modified scale, were recorded during the follow-up. According to this scale, Rankin of 0 to 2 was considered as a favorable prognosis. RESULTS: This series represents 8.6 of all the SAH cases in our hospital. In 6 cases (12%), there was a causal relationship between the use of sympathicomimetic drugs and the development of SAH. In 80% of them, it was not possible to document the cause of the hemorrhage, while difference causes )cerebral venous thrombosis in 4 [8%], spontaneous dissection of the vertebral artery in 2 [4%], vasculitis secondary to neurocystecerosis in 2 [4%], cavernous angioma in 1 [2%] and spinal arteriovenous malformation in 1) were found. Rebleeding did not occur in any of the cases and only one patient died. In 45 patients (90%), the final functional prognosis was good (Rankin 0-2). We found no significant differences between the tomographic pattern of the hemorrhage, initial clinical condition and long term prognosis. CONCLUSIONS: Our findings show a low frequency of nonaneurysmal SAH in our population and a diversity of causes greater than those reported by other series. The good functional prognosis in these cases was confirmed.
Assuntos
Hemorragia Subaracnóidea/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Malformações Arteriovenosas/complicações , Dano Encefálico Crônico/epidemiologia , Dano Encefálico Crônico/etiologia , Bases de Dados Factuais , Feminino , Seguimentos , Hemangioma Cavernoso/complicações , Humanos , Hipertensão/complicações , Trombose Intracraniana/complicações , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Neurocisticercose/complicações , Prognóstico , Estudos Prospectivos , Recidiva , Fatores de Risco , Hemorragia Subaracnóidea/etiologia , Simpatomiméticos/efeitos adversos , Dissecação da Artéria Vertebral/complicaçõesRESUMO
Efedrinas sao aminas simpatomiméticas componentes de diversas especialidades farmacêuticas, utilizadas no tratamento de doenças respiratórias devido à sua ação descongestionante e broncodilatora. Atualmente, diversos produtos comercializados como suplementos nutricionais contêm efedrinas e são amplamente utilizados no meio esportivo, com o objetivo de facilitar a queima de gorduras e melhorar o desempenho. Entretanto, o uso indiscriminado destas substâncias pode acarretar série de efeitos tóxicos como hipertensão, taquicardia, cefaléia e tremores. Devido à sua ação psicoestimulante, foram incluídas na lista de substâncias proibidas nas atividades esportivas pelo Comitê Olímpico Internacional (COI) e estabelecidas...
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Masculino , Feminino , Humanos , Dopagem Esportivo , Simpatomiméticos/efeitos adversos , Simpatomiméticos/toxicidade , Simpatomiméticos/uso terapêutico , Detecção do Abuso de Substâncias , Cromatografia Gasosa , Urina , Qualidade da ÁguaRESUMO
BACKGROUND: When efforts to resuscitate a child after cardiac arrest are unsuccessful despite the administration of an initial dose of epinephrine, it is unclear whether the next dose of epinephrine (i.e., the rescue dose) should be the same (standard) dose or a higher dose. METHODS: We performed a prospective, randomized, double-blind trial to compare high-dose epinephrine (0.1 mg per kilogram of body weight) with standard-dose epinephrine (0.01 mg per kilogram) as rescue therapy for in-hospital cardiac arrest in children after failure of an initial, standard dose of epinephrine. The trial included 68 children, and Utstein-style reporting guidelines were used. The primary outcome measure was survival 24 hours after the arrest. RESULTS: The rate of survival at 24 hours was lower in the group assigned to a high dose of epinephrine as rescue therapy than in the group assigned to a standard dose: 1 of the 34 patients in the high-dose group survived for 24 hours, as compared with 7 of the 34 patients in the standard-dose group (unadjusted odds ratio for death with the high dose, 8.6; 97.5 percent confidence interval, 1.0 to 397.0; P=0.05). After adjustment by multiple logistic-regression analysis for differences in the groups at the time of arrest, the high-dose group tended to have a lower 24-hour survival rate (odds ratio for death, 7.9; 97.5 percent confidence interval, 0.9 to 72.5; P=0.08). The two treatment groups did not differ significantly in terms of the rate of return of spontaneous circulation (which occurred in 20 patients in the high-dose group and 21 of those in the standard-dose group; odds ratio, 1.1; 97.5 percent confidence interval, 0.4 to 3.0). None of the patients in the high-dose group, as compared with four of those in the standard-dose group, survived to hospital discharge. Among the 30 patients whose cardiac arrest was precipitated by asphyxia, none of the 12 who were assigned to high-dose epinephrine were alive at 24 hours, as compared with 7 of the 18 who were assigned to a standard dose (P=0.02). CONCLUSIONS: We did not find any benefit of high-dose epinephrine rescue therapy for in-hospital cardiac arrest in children after failure of an initial standard dose of epinephrine. The data suggest that high-dose therapy may be worse than standard-dose therapy.
Assuntos
Reanimação Cardiopulmonar , Epinefrina/administração & dosagem , Parada Cardíaca/tratamento farmacológico , Simpatomiméticos/administração & dosagem , Asfixia/complicações , Asfixia/mortalidade , Criança , Pré-Escolar , Relação Dose-Resposta a Droga , Método Duplo-Cego , Epinefrina/efeitos adversos , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/mortalidade , Parada Cardíaca/terapia , Mortalidade Hospitalar , Humanos , Lactente , Masculino , Estudos Prospectivos , Terapia de Salvação , Choque/complicações , Choque/mortalidade , Taxa de Sobrevida , Simpatomiméticos/efeitos adversosRESUMO
BACKGROUND AND PURPOSE: Phenylpropanolamine (PPA) and pseudoephedrine are sympathomimetics contained in over-the-counter cold preparations. A case-control study linked PPA use with hemorrhagic stroke in women. Twenty-two patients with stroke associated with use of these drugs are described. METHODS: In a consecutive stroke registry since 1988, 22 patients had stroke associated with over-the-counter sympathomimetics. Sympathomimetic dosage and type, time interval until stroke onset, and neuroimaging findings are described. RESULTS: Ten male and 12 female patients were included. Intracerebral hemorrhage occurred in 17 patients, subarachnoid hemorrhage in 4, and ischemic stroke in 1. Stroke was associated with PPA use in 16 patients (dose 75 to 675 mg), with pseudoephedrine in 4 (dose 60 to 300 mg), and with others administered by the nasal route in 2 (oxymetazoline and phenylephrine). Stroke occurred after a single dose in 17 patients and after daily use during several days in 5. The interval between drug exposure and clinical onset varied from 30 minutes to 24 hours. Stroke occurred after recommended doses of PPA (50 to 75 mg) in 32% and pseudoephedrine (60 mg) in 50% of patients. Eight patients had acute hypertension at stroke onset. Cerebral angiography was normal in 8 cases and showed diffuse vasospasm or beading in 10 patients. CONCLUSIONS: Stroke related to over-the-counter sympathomimetics was associated with acute hypertension and/or vasospasm or angiitis mechanisms, most related to the use of PPA; however, stroke also occurred with the use of other sympathomimetics, particularly pseudoephedrine. Although stroke complications occurred when doses were used that were higher than recommended doses, apparently there is also a stroke risk when these agents are taken properly.
Assuntos
Efedrina/efeitos adversos , Medicamentos sem Prescrição/efeitos adversos , Fenilpropanolamina/efeitos adversos , Acidente Vascular Cerebral/induzido quimicamente , Simpatomiméticos/efeitos adversos , Adolescente , Adulto , Idoso , Isquemia Encefálica/induzido quimicamente , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Estudos de Casos e Controles , Causalidade , Hemorragia Cerebral/induzido quimicamente , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/epidemiologia , Comorbidade , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Oximetazolina/efeitos adversos , Prognóstico , Estudos Prospectivos , Sistema de Registros , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Hemorragia Subaracnóidea/induzido quimicamente , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/epidemiologiaRESUMO
The enzymatic activity of the mitochondrial oligomycin-sensitive ATPase was investigated during isoproterenol-induced cell injury of myocardium, using rat heart homogenates and a potentiometric method. The enzymatic activity of the oligomycin-sensitive ATPase and the inhibitory action of oligomycin do not show significant alterations upon treatment with isoproterenol. These results are inconsistent with the hypothesis that modifications in the active configuration of the mitochondrial ATPase take place during isoproterenol-induced injury of myocardium.