RESUMEN
INTRODUCTION: A high number of women are exposed to acetaminophen during pregnancy worldwide. This drug safety during pregnancy regarding preterm birth, birth weight, and fetal development has not been well described. This study investigated the effect of acetaminophen use during pregnancy on selected adverse pregnancy outcomes. AREAS COVERED: Databases were searched to identify studies reporting the effects of acetaminophen use during pregnancy on preterm birth, low birth weight, and small for gestational age. The studies' quality was assessed by the Newcastle-Ottawa Scale and the Methodological Index for Non-Randomized Studies. Risk ratios with 95% confidence intervals were estimated using a fixed or random-effects model. Six studies were included for final review, four cohort and two case-control studies. We found no increased risk of preterm birth (RR 0.97; 95% CI 0.59-1.58), and decreased risks of low birth weight (RR 0.65; 95% CI 0.59-0.72) and small for gestational age (RR 0.69; 95% CI 0.50-0.97). Acetaminophen exposure during the third trimester revealed non-significantly in the outcomes. EXPERT OPINION: Exposure to acetaminophen during pregnancy appears to not increase the risk of the outcomes analyzed. However, there is a lack of information regarding the exposure dose and frequency of acetaminophen use.
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Acetaminofén/administración & dosificación , Analgésicos no Narcóticos/administración & dosificación , Resultado del Embarazo , Acetaminofén/efectos adversos , Analgésicos no Narcóticos/efectos adversos , Peso al Nacer/efectos de los fármacos , Femenino , Desarrollo Fetal/efectos de los fármacos , Humanos , Recién Nacido , Embarazo , Tercer Trimestre del Embarazo , Nacimiento Prematuro/epidemiologíaRESUMEN
RATIONALE, AIMS, AND OBJECTIVES: Misunderstanding medication dosage regimen instructions can lead to unintentional misuse of a prescribed medicine, non-adherence to providers' instructions, and other treatment-related issues. We aimed to evaluate the frequency of and factors associated with older patients' misunderstanding of medication dosage regimen instructions after consultation with a general practitioner. METHOD: This cross-sectional study was conducted in 22 primary-care facilities in Brazil. Data were collected from September 2016 to December 2017 using a multidimensional questionnaire. Patients who were 60 years old or older who visited primary care units were included in the study (n = 416). RESULTS: Of the older patients interviewed, 38.2% had a misunderstanding of medication dosage regimen instructions; being female was a protective factor against the misunderstanding of medication dosage regimen instructions (prevalence ratio [PR] = 0.63; 95% confidence interval [CI] = 0.45-0.89). In relation to other factors with an important association, misunderstanding medication dosage regimen instructions was 71% higher among illiterate participants (PR = 1.71; 95% CI = 1.25-2.35), 39% higher among people who considered their memory to be poor (PR = 1.39; 95% CI = 1.01-1.91), 49% higher in those who did not have a job at the time of the interview (PR = 1.49; 95% CI = 1.01-2.19), and 50% higher in patients who had been prescribed five or more medications (PR = 1.50; 95% CI = 1.02-2.20). CONCLUSIONS: The results showed that older people's misunderstandings of medication dosage regimen instructions after consultation with a general practitioner was greater than expected due to a range of factors, especially polypharmacy, poor literacy, poor memory, and having a job at the time of the interview. Health services and professionals should implement strategies to increase the quality of the guidance given to elderly individuals and to ensure their adherence to the regimen instructions of their medications.
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Polifarmacia , Atención Primaria de Salud , Anciano , Brasil , Estudios Transversales , Femenino , Humanos , Cumplimiento de la Medicación , Persona de Mediana Edad , Derivación y ConsultaRESUMEN
OBJECTIVE: The objective was to determine the circadian rhythm of melatonin in the Smith-Magenis syndrome (SMS), which causes behavioral problems and sleep disturbance. STUDY DESIGN: Questionnaires, sleep consultations, and sleep diaries were obtained in 20 children with SMS (9 girls, 11 boys aged 4 to 17 years). Actigraphy, electroencephalography, and the circadian variations of plasma melatonin, cortisol, and growth hormone were recorded in 8 patients. Early sleep onset, early sleep offset, and sleep attack indicated sleep disturbance. RESULTS: All children with SMS had a phase shift of their circadian rhythm of melatonin. Time at onset of melatonin secretion was 6 AM +/- 2 (control group: 9 P.M. +/- 2). Peak time was 12 PM +/- 1 (control group: 3:30 AM +/- 1:30), and melatonin offset was at 8 PM +/- 1 (control group: 6 AM +/- 1). Behavioral problems correlated with the inverted circadian rhythm of melatonin. CONCLUSION: Considering that clock genes mediate the generation of circadian rhythms, we suggest that haploinsufficiency for a circadian system gene mapping to chromosome 17p11.2 may cause the inversion of the circadian rhythm of melatonin in SMS.
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Anomalías Múltiples/genética , Trastornos de la Conducta Infantil/genética , Cromosomas Humanos Par 17 , Ritmo Circadiano , Melatonina/metabolismo , Trastornos del Sueño-Vigilia/genética , Adolescente , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Eliminación de Gen , Humanos , Masculino , Mutación , SíndromeRESUMEN
From October 1985 to November 1987, 150 out of 845 newborns hospitalized in the Pointe-a-Pitre Hospital Neonatal Care Unit have received total parenteral nutrition (TPN). Two hundred and four catheterizations have been performed on 150 newborns, 74 per cent less than 2,000 gm birth weight. Sixty-one per cent of the latter were less than 32 weeks of gestation. Indications for TPN were as follows: 66 (44 per cent)less than 1,500 gm birth weight (6 with necrotizing enterocolitis), 84 (56 per cent) 1,500 gm or more birth weight, 47 with pre-existing perpartum distress, 22 with gastrointestinal disorders, 11 with necrotizing enterocolitis and 4 with gastrointestinal congenital malformations. On average, central venous catheterization was performed on the eighth day of life, and infusion time was 25 days. The commonly observed TPN complications are glucose intolerance, hepatic cholestasis and phosphocalcific metabolism disorders (osteoporosis, ricketts). A clear-cut distinction is made between an introductory phase of the technique (1985-1986), and a second phase where better prevention of complications was achieved (1986-1987). TPN has become a necessary alternative for the management of newborns at high risk with gastrointestinal problems. In our patients, it has produced an average daily weight gain of 21 gm (AU)