RESUMEN
OBJECTIVE: The benefit of atropine in pediatric tracheal intubation is not well established. The objective of this study was to evaluate the effect of atropine on the incidence of hypoxemia and bradycardia during tracheal intubations in the pediatric emergency department. METHODS: This is a single-center observational study in a tertiary pediatric emergency department. Data were collected on all tracheal intubations in patients from 31 days to incomplete 20 years old, performed between January 2016 and September 2020. Procedures were divided into two groups according to the use or not of atropine as a premedication during intubation. Records with missing data, patients with cardiorespiratory arrest, cyanotic congenital heart diseases, and those with chronic lung diseases with baseline hypoxemia were excluded. The primary outcome was hypoxemia (peripheral oxygen saturation ≤88%), while the secondary outcomes were bradycardia (decrease in heart rate >20% between the maximum and minimum values) and critical bradycardia (heart rate <60 bpm) during intubation procedure. RESULTS: A total of 151 tracheal intubations were identified during the study period, of which 126 were eligible. Of those, 77% had complex, chronic underlying diseases. Atropine was administered to 43 (34.1%) patients and was associated with greater odds of hypoxemia in univariable analysis (OR: 2.62; 95%CI 1.15-6.16; p=0.027) but not in multivariable analysis (OR: 2.07; 95%CI 0.42-10.32; p=0.37). Critical bradycardia occurred in only three patients, being two in the atropine group (p=0.26). Bradycardia was analyzed in only 42 procedures. Atropine use was associated with higher odds of bradycardia in multivariable analysis (OR: 11.00; 95%CI 1.3-92.8; p=0.028). CONCLUSIONS: Atropine as a premedication in tracheal intubation did not prevent the occurrence of hypoxemia or bradycardia during intubation procedures in pediatric emergency.
Asunto(s)
Atropina , Bradicardia , Niño , Humanos , Atropina/uso terapéutico , Bradicardia/epidemiología , Bradicardia/prevención & control , Bradicardia/complicaciones , Servicio de Urgencia en Hospital , Hipoxia/etiología , Hipoxia/prevención & control , Hipoxia/tratamiento farmacológico , Intubación Intratraqueal/efectos adversos , Intubación Intratraqueal/métodos , Lactante , Preescolar , AdolescenteRESUMEN
Objetivo: Comparar la efectividad del tratamiento de atropina versus oclusión ocular en pacientes con ambliopía refractiva moderada unilateral. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo de una serie de casos que acudieron a la consulta de Oftalmología Pediátrica del Instituto Cubano de Oftalmología Ramón Pando Ferrer durante el período comprendido de septiembre del 2019 a septiembre de 2021. La muestra quedó conformada por 44 pacientes, los cuales se dividieron de forma aleatoria en dos grupos de estudio, 22 casos al grupo de oclusiones e igual número al grupo de atropina, que cumplían los criterios de inclusión. Se analizaron las variables edad, sexo, defecto refractivo, agudeza visual mejor corregida, sensibilidad al contraste y estereopsis. Resultados: Predominó el astigmatismo hipermetrópico en ambos grupos de estudio. La media de la agudeza visual mejor corregida inicial en ambos grupos fue de 0,4 LogMAR y mejoró a 0,1 LogMAR al finalizar el tratamiento. La media de la sensibilidad al contraste inicial fue de 1,48 (±19,75) para el grupo de oclusiones y de 1,47 (±20,5) para el grupo atropina, al finalizar alcanzaron 1,59 (±10,1) y 1,57 (±10,0) por orden de mención. La estereopsis inicial fue subnormal en ambos grupos, al finalizar el tratamiento fue normal en el 77,3 por ciento grupo oclusión y el 68,2 por ciento grupo atropina. Conclusiones: La efectividad del tratamiento en pacientes con ambliopía refractiva moderada unilateral con atropina es similar a la que se alcanza con la aplicación de la oclusión ocular(AU)
Objective: To compare the effectiveness of atropine treatment versus ocular occlusion in patients with unilateral moderate refractive amblyopia. Methods: A descriptive, longitudinal and prospective study of a series of cases that attended the Pediatric Ophthalmology office of the Ramón Pando Ferrer Cuban Institute of Ophthalmology during the period from September 2019 to September 2021 was carried out. The sample consisted of 44 patients, who were randomly divided into two study groups, 22 cases to the occlusion group and the same number to the atropine group, who met the inclusion criteria. The variables age, gender, refractive defect, best corrected visual acuity, contrast sensitivity and stereopsis were analyzed. Results: Hypermetropic astigmatism predominated in both study groups. Average initial best-corrected visual acuity in both groups was 0.4 LogMAR and improved to 0.1 LogMAR at the end of treatment. Average initial contrast sensitivity was 1.48 (±19.75) for the occlusion group and 1.47 (±20.5) for the atropine group, at completion reaching 1.59 (±10.1) and 1.57 (±10.0) in order of mention. Initial stereopsis was subnormal in both groups, at the end of treatment it was normal in 77.3 percent occlusion group and 68.2 percent atropine group. Conclusions: The effectiveness of treatment in patients with unilateral moderate refractive amblyopia with atropine is similar to that achieved with the application of ocular occlusion(AU)
Asunto(s)
Humanos , Niño , Atropina/uso terapéutico , Ambliopía/etiología , Epidemiología Descriptiva , Estudios LongitudinalesRESUMEN
PURPOSE: To explore the therapeutic effects of orthokeratology lens combined with 0.01% atropine eye drops on juvenile myopia. METHODS: A total of 340 patients with juvenile myopia (340 eyes) treated from 2018 to December 2020 were divided into the control group (170 cases with 170 eyes, orthokeratology lens) and observation group (170 cases with 170 eyes, orthokeratology lens combined with 0.01% atropine eye drops). The best-corrected distance visual acuity, best-corrected near visual acuity, diopter, axial length, amplitude of accommodation, bright pupil diameter, dark pupil diameter, tear-film lipid layer thickness, and tear break-up time were measured before treatment and after 1 year of treatment. The incidence of adverse reactions was observed. RESULTS: Compared with the values before treatment, the spherical equivalent degree was significantly improved by 0.22 (0.06, 0.55) D and 0.40 (0.15, 0.72) D in the observation and control groups after the treatment, respectively (p<0.01). After the treatment, the axial length was significantly increased by (0.15 ± 0.12) mm and (0.24 ± 0.11) mm in the observation and control groups, respectively, (p<0.01). After the treatment, the amplitude of accommodation significantly declined in the observation group and was lower than that in the control group, whereas both bright and dark pupil diameters significantly increase and were larger than those in the control group (p<0.01). After the treatment, the tear-film lipid layer thickness and tear break-up time significantly declined in the two groups (p<0.01). CONCLUSIONS: Orthokeratology lens combined with 0.01% atropine eye drops can synergistically enhance the control effect on juvenile myopia with high safety.
Asunto(s)
Atropina , Midriáticos , Miopía , Soluciones Oftálmicas , Procedimientos de Ortoqueratología , Agudeza Visual , Humanos , Atropina/administración & dosificación , Atropina/uso terapéutico , Soluciones Oftálmicas/administración & dosificación , Miopía/terapia , Miopía/tratamiento farmacológico , Procedimientos de Ortoqueratología/métodos , Femenino , Masculino , Niño , Agudeza Visual/efectos de los fármacos , Adolescente , Resultado del Tratamiento , Midriáticos/administración & dosificación , Midriáticos/uso terapéutico , Lágrimas/efectos de los fármacos , Lágrimas/fisiología , Acomodación Ocular/efectos de los fármacos , Longitud Axial del Ojo/efectos de los fármacos , Refracción Ocular/efectos de los fármacos , Refracción Ocular/fisiologíaRESUMEN
INTRODUCTION: Accidental or intentional intoxication by organophosphates, which are toxic substances that inhibit acetylcholinesterase, constitutes a serious public health problem worldwide, with a greater impact in developing countries. Chronic intoxication during pregnancy with alterations in neurodevelopment and fetal growth has been described. OBJECTIVE: To describe an unusual case of transplacentally acquired organophosphorus poisoning, highlighting the clinical presentation, the management with atropine, and the neurological outcome. CLINICAL CASE: 36-weeks premature newborn, whose mother presented acute intentional organophosphorus poisoning 17 hours before birth. The patient was born by emergency C-section, without respiratory distress, with bradycardia, hypotonia, miosis, and bron- chorrhea, as well as clinical signs and laboratory evidence of acute poisoning, with severe metabolic acidosis, and decreased cholinesterase activity. She required advanced resuscitation, management in the Neonatal Intensive Care Unit with invasive ventilation, inotropes, and repeated doses of atropine. She evolved with left hemiparesis and convulsive syndrome that was treated with phenobarbital. She was discharged at 34 days of life with her mother, under custody and supervision of social and family welfare. Treatment and follow-up were suspended until her first year of life when her custody was transferred to an aunt. In neurological control at 18 months, she presented persistence of hemiparesis and speech-language delay, without new seizures. CONCLUSIONS: Organophosphorus poisoning is very rare in the neonatal period and due to the absence of guidelines for the management of this type of patients its treatment is challenging and must be individualized, multidisciplinary, evaluating the risk and benefit of each intervention.
Asunto(s)
Intoxicación por Organofosfatos , Acetilcolinesterasa , Atropina/uso terapéutico , Colinesterasas , Femenino , Humanos , Recién Nacido , Intoxicación por Organofosfatos/tratamiento farmacológico , Organofosfatos , EmbarazoRESUMEN
OBJECTIVE: To assess the procedural and clinical outcomes associated with the introduction of minimally invasive surfactant therapy (MIST) into standard care at 2 tertiary Australian neonatal intensive care units. STUDY DESIGN: A prospective audit was designed before the introduction of MIST in 2018, with data collected over a period of 18 months. Procedural data were completed by the clinical team performing MIST, including clinical observations, medication use, and adverse events. The audit team collected demographic data and subsequent clinical outcomes from medical records. RESULTS: There were 135 MIST procedures recorded in 122 infants. For the included infants, the median gestation was 302/7 weeks (IQR, 276/7 to 322/7 weeks) and birth weight was 1439 g (IQR, 982-1958 g). During the MIST procedure, desaturation to a peripheral oxygen saturation of <80% was common, occurring in 75.2% of procedures. Other adverse events included need for positive pressure ventilation (10.6%) and bradycardia <100 beats per minute (13.3%). The use of atropine premedication was associated with a significantly lower incidence of bradycardia: 8.6% vs 52.9% (P < .01). Senior clinicians demonstrated higher rates of procedural success. The majority of infants (63.9%) treated with MIST did not require subsequent intubation and mechanical ventilation. CONCLUSIONS: MIST can be successfully introduced in neonatal units with limited experience of this technique. The use of atropine premedication decreases the incidence of bradycardia during the procedure. Success rates can be optimized by limiting MIST to clinicians with greater competence in endotracheal intubation.
Asunto(s)
Intubación Intratraqueal , Surfactantes Pulmonares/administración & dosificación , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Antiarrítmicos/uso terapéutico , Atropina/uso terapéutico , Australia/epidemiología , Bradicardia/etiología , Bradicardia/prevención & control , Auditoría Clínica , Competencia Clínica , Femenino , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Masculino , Oxígeno/sangre , Respiración con Presión Positiva/estadística & datos numéricos , Premedicación , Estudios ProspectivosRESUMEN
La intoxicación por betabloqueadores es una situación clínica de poca frecuencia, estrechamente relacionada con trastornos depresivos mayores, con una prevalencia mayor en mujeres. Los episodios de gravedad relacio- nados a toxicidad por betabloqueadores son clasificados como episodios de moderados a severos. En el caso del carvedilol con un umbral tóxico de 50mg. Caso Clínico: Paciente de 16 años con historia de ingesta de carvedilol en niveles tóxicos y único antecedente depresión ma- yor. Discusión: Los betabloqueadores antagonizan los receptores betaadrenérgicos, la sintomatología relacio- nada con bradicardia e hipotensión es frecuente y puede generar afección a nivel del sistema nervioso central. El tratamiento de emergencia sí se capta al paciente en la primera hora consiste en realizar un lavado gástrico y aplicar carbón activado. Se propone el uso de crista- loides y el uso de epinefrina o norepinefrina como ma- nejo de primera línea, en caso de bradicardias sosteni- das debe considerarse el uso de atropina. Los pacientes asintomáticos deben ser vigilados durante seis horas...(AU)
Asunto(s)
Humanos , Masculino , Adolescente , Antagonistas Adrenérgicos beta/toxicidad , Carvedilol/toxicidad , Atropina/uso terapéutico , Carbón Orgánico/uso terapéuticoRESUMEN
A reanimação cérebro-cardio-respiratória na medicina veterinária é uma área que merece bastante estudo e aprimoramento, visto que, na rotina, cada profissional acaba tomando uma conduta diferente. Partindo deste fato, é importante estabelecer o correto diagnóstico da parada e utilizar o que existe de mais recente, se baseando em comprovações científicas, para conseguir o sucesso de sua reversão. O objetivo desta revisão foi compilar tudo o que vem sendo escrito e publicado de mais atual referente ao tema, em pequenos animais, no intuito de mostrar aos médicos veterinários atuantes na área clínica, mecanismos de realizar a melhor conduta possível mediante a parada cárdiorespiratória.(AU)
The brain-cardio-respiratory resuscitation in veterinary medicine is an area that deserves a lot of study and improvement, since in the routine, each professional ends up taking a different course. Starting from this fact, it is important to establish the correct diagnosis of the stop and to use what is of the most recent, based on scientific evidence, to achieve the success of its revertion. The objective of this review was to compile all that has been written and published of the most recent one referring to the subject, in small animals, in order to show to veterinarians working in the clinical area, the mechanisms to perform the best possible behavior through the cardiacarrest.(AU)
La reanimación cerebro-cardio-respiratoria en medicina veterinaria es un área que merece mucho estudio y mejora, ya que, en la rutina, cada profesional termina adoptando un enfoque diferente. En base a este hecho, es importante establecer el diagnóstico correcto de la detención y utilizar el más reciente, basado en evidencia científica, para lograr el éxito de su reversión. El propósito de esta revisión fue recopilar todo lo que se ha escrito y publicado sobre lo último en el tema, en animales pequeños, con el fin de mostrar a los veterinarios que trabajan en el área clínica, los mecanismos para llevar a cabo la mejor conducta posible a través del paro cardiopulmonar.(AU)
Asunto(s)
Animales , Gatos , Perros , Reanimación Cardiopulmonar/métodos , Reanimación Cardiopulmonar/veterinaria , Paro Cardíaco/veterinaria , Epinefrina/uso terapéutico , Vasopresinas/uso terapéutico , Atropina/uso terapéuticoRESUMEN
A reanimação cérebro-cardio-respiratória na medicina veterinária é uma área que merece bastante estudo e aprimoramento, visto que, na rotina, cada profissional acaba tomando uma conduta diferente. Partindo deste fato, é importante estabelecer o correto diagnóstico da parada e utilizar o que existe de mais recente, se baseando em comprovações científicas, para conseguir o sucesso de sua reversão. O objetivo desta revisão foi compilar tudo o que vem sendo escrito e publicado de mais atual referente ao tema, em pequenos animais, no intuito de mostrar aos médicos veterinários atuantes na área clínica, mecanismos de realizar a melhor conduta possível mediante a parada cárdiorespiratória.
The brain-cardio-respiratory resuscitation in veterinary medicine is an area that deserves a lot of study and improvement, since in the routine, each professional ends up taking a different course. Starting from this fact, it is important to establish the correct diagnosis of the stop and to use what is of the most recent, based on scientific evidence, to achieve the success of its revertion. The objective of this review was to compile all that has been written and published of the most recent one referring to the subject, in small animals, in order to show to veterinarians working in the clinical area, the mechanisms to perform the best possible behavior through the cardiacarrest.
La reanimación cerebro-cardio-respiratoria en medicina veterinaria es un área que merece mucho estudio y mejora, ya que, en la rutina, cada profesional termina adoptando un enfoque diferente. En base a este hecho, es importante establecer el diagnóstico correcto de la detención y utilizar el más reciente, basado en evidencia científica, para lograr el éxito de su reversión. El propósito de esta revisión fue recopilar todo lo que se ha escrito y publicado sobre lo último en el tema, en animales pequeños, con el fin de mostrar a los veterinarios que trabajan en el área clínica, los mecanismos para llevar a cabo la mejor conducta posible a través del paro cardiopulmonar.
Asunto(s)
Animales , Gatos , Perros , Paro Cardíaco/veterinaria , Reanimación Cardiopulmonar/métodos , Reanimación Cardiopulmonar/veterinaria , Atropina/uso terapéutico , Epinefrina/uso terapéutico , Vasopresinas/uso terapéuticoRESUMEN
RESUMEN Se presenta un caso clínico de un varón de 27 años de edad, con una ectasia corneal y presencia de queratoglobo en ambos ojos. La manifestación clínica fue disminución lenta y progresiva de la agudeza visual en ambos ojos y dolor en el ojo izquierdo. Al examen oftalmológico se constató hidrops corneal agudo en ojo izquierdo y otras complicaciones corneales, propias de esta anomalía. Se realizó un estudio oftalmológico que permitió un diagnóstico certero. Se aplicó la terapéutica correspondiente y se sugirieron otras opciones terapéuticas (AU).
ABSTRACT We present the clinical case of a male patient, aged 27 years, with corneal ectasia and keratoglobus in both eyes. The clinical manifestation was progressive and slow decrease of the visual acuity in both eyes and pain in the left eye. At the ophthalmologic examination, acute corneal hydrops was found in the left eye, and also other complications that are proper of this anomaly. An ophthalmologic study was carried out that lead to an accurate diagnosis. The correspondent therapy was applied and several therapeutic options were suggested (AU).
Asunto(s)
Humanos , Masculino , Adulto , Atropina/uso terapéutico , Trastornos de la Visión , Enfermedades de la Córnea/diagnóstico , Personas con Daño Visual , Perforación Corneal/prevención & control , Queratocono/diagnóstico , Agudeza Visual , Topografía de la Córnea , Anteojos , Queratocono/congénito , Queratocono/etiología , Queratocono/tratamiento farmacológico , Queratocono/epidemiologíaRESUMEN
RESUMEN Se presenta un caso clínico de un varón de 27 años de edad, con una ectasia corneal y presencia de queratoglobo en ambos ojos. La manifestación clínica fue disminución lenta y progresiva de la agudeza visual en ambos ojos y dolor en el ojo izquierdo. Al examen oftalmológico se constató hidrops corneal agudo en ojo izquierdo y otras complicaciones corneales, propias de esta anomalía. Se realizó un estudio oftalmológico que permitió un diagnóstico certero. Se aplicó la terapéutica correspondiente y se sugirieron otras opciones terapéuticas (AU).
ABSTRACT We present the clinical case of a male patient, aged 27 years, with corneal ectasia and keratoglobus in both eyes. The clinical manifestation was progressive and slow decrease of the visual acuity in both eyes and pain in the left eye. At the ophthalmologic examination, acute corneal hydrops was found in the left eye, and also other complications that are proper of this anomaly. An ophthalmologic study was carried out that lead to an accurate diagnosis. The correspondent therapy was applied and several therapeutic options were suggested (AU).
Asunto(s)
Humanos , Masculino , Adulto , Atropina/uso terapéutico , Trastornos de la Visión , Enfermedades de la Córnea/diagnóstico , Personas con Daño Visual , Perforación Corneal/prevención & control , Queratocono/diagnóstico , Agudeza Visual , Topografía de la Córnea , Anteojos , Queratocono/congénito , Queratocono/etiología , Queratocono/tratamiento farmacológico , Queratocono/epidemiologíaRESUMEN
Nicotine is a dangerous substance extracted from tobacco leaves. When nicotine is absorbed in excessive amounts, it can lead to respiratory failure and cardiac arrest. The commercialization of electronic cigarettes (e-cigarettes) has allowed users to directly handle e-cigarette liquid. Consequently, the risk of liquid nicotine exposure has increased. We describe our experience of managing the case of a patient who orally ingested a high concentration of liquid nicotine from e-cigarette liquid. The patient presented with bradycardia and hypotension, which are symptoms of parasympathetic stimulation, together with impaired consciousness. He recovered following treatment with atropine and a vasopressor.
Asunto(s)
Bradicardia/etiología , Sistemas Electrónicos de Liberación de Nicotina , Nicotina/envenenamiento , Atropina/uso terapéutico , Bradicardia/tratamiento farmacológico , Humanos , Hipotensión/tratamiento farmacológico , Hipotensión/etiología , Masculino , Persona de Mediana Edad , Vasoconstrictores/uso terapéuticoRESUMEN
Resumo Objetivo: Demonstrar a eficácia do uso do colírio de atropina 0,025% em crianças míopes, no Brasil, para a diminuição da progressão da miopia. Métodos: Realizou-se estudo prospectivo em 60 pacientes do Hospital Geral Universitário e Oftalmocenter Santa Rosa - Cuiabá - MT, com idades entre 6 e 12 anos, com equivalente esférico da refração entre -1,00 a -6,00 DE, refração cilíndrica < -1,00 DC e taxa de progressão anual de 0,50 DE (ou maior). Efetuou-se exame oftalmológico geral, topografia corneana e a medida do diâmetro anteroposterior do globo ocular (DAP). Os pacientes foram divididos em dois grupos: em que o Grupo 1 recebeu colírio de atropina 0,025%, todas as noites, e prescreveu-se a refração total com lentes com antirreflexo de multicamadas; e, no Grupo 2, somente a refração total. Nova avaliação foi realizada dois anos após. O teste T Student pareado foi utilizado para comparações das refrações, DAP e ceratometrias, medidas no exame inicial e no exame com 2 anos de seguimento. Resultados: Das 60 crianças, 30 eram do Grupo 1 com idade média de 8,21 ± 1,72 anos, e as do grupo controle com idade média de 8,17 ± 1,73 anos. Quatorze (46,66%) e 16 (53,33%) eram do sexo masculino nos Grupos 1 e 2, respectivamente. O Grupo 1 revelou menor progressão da miopia (Grupo 1: 0,43 ± 0,19D, Grupo 2: 1,24 ± 0,37D) e menor crescimento do DAP em relação ao grupo controle (Grupo 1: 0,19 ± 0,09mm, Grupo 2: 0,48 ± 0,12mm). Houve diferença estatisticamente significativa (P<0,05) entre o grupo tratado e o controle em relação à refração e ao crescimento DAP. A topografia não teve mudança estatisticamente significativa. Conclusão: A atropina em baixas concentrações foi eficaz em diminuir a progressão da miopia em 65% desta população estudada, por 2 anos. No entanto estudos com maior número de participantes e em diversas regiões do Brasil poderiam demonstrar melhor esse fato.
Abstract Purpose: To demonstrate the efficacy of 0.025% atropine eyedrops in myopic children in Brazil for decreasing myopia progression Methods: This was a prospective study with 60 children from Hospital Geral Universitário and Oftalmocenter Santa Rosa in Cuiabá, MT, Brazil, aged between 6 to 12 years, with spherical equivalent refractive error of -1.00 to -6.00 diopters (D) and astigmatism of -1.00 D or smaller. They underwent a complete ophthalmological examination, corneal topography and optical biometry. Children were assigned into two groups: group 1 used 0.025% atropine drop, once-nightly dosing, and it was prescribed total refraction in anti-reflective coating lens; and group 2 was prescribed just total refraction. A new evaluation was conducted 2 years after that. Paired student's t-test was used to compare refractions, axial length and keratometry which were measured in an initial exam and after a two-year follow-up. Results: Of the 60 children, the 30 in group 1 had an age mean and SD 8.21 +/- 1.72, and of the control group were 8.17 +/- 1.73 years. Fourteen (46,66%) and 16 (53,33%) were male, respectively. Myopic progression was significantly lower in group 1 (-0.43 +/- 0.19 D) than in group 2 (-1.24 +/- 0.37 D) and axial length increase was also significantly smaller in group 1(0.19 +/- 0.09 mm) than in group 2 (0.48 +/- 0.12 mm). There were no significant statistical differences regarding keratometry between groups. Conclusions: Low dose atropine eyedrops were effective in decreasing myopia progression in 65% of this population studied for 2 years. Furthermore, a larger scale randomized controlled study with longer follow-up seems warranted.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Atropina/administración & dosificación , Atropina/uso terapéutico , Miopía/prevención & control , Miopía/tratamiento farmacológico , Soluciones Oftálmicas , Oftalmoscopía , Refracción Ocular , Errores de Refracción , Tonometría Ocular , Agudeza Visual , Estudios Prospectivos , Estudios Longitudinales , Biometría , Progresión de la Enfermedad , Topografía de la Córnea , Técnicas de Diagnóstico Oftalmológico , Administración Oftálmica , Instituciones de Atención Ambulatoria , Miopía/diagnósticoRESUMEN
RESUMO A nicotina é uma substância perigosa, extraída das folhas de fumo. Quando absorvida em quantidade excessiva, ela pode levar à insuficiência respiratória e à parada cardíaca. A comercialização de cigarros eletrônicos (e-cigarros) permite que os usuários manuseiem diretamente o líquido, com consequente aumento do risco de exposição à nicotina líquida. Descrevemos nossa experiência no tratamento do caso de um paciente que ingeriu elevada concentração de nicotina líquida contida em líquido para e-cigarros. O paciente apresentava bradicardia e hipotensão, que são sintomas de estimulação parassimpática, além de comprometimento da consciência. O paciente teve recuperação após tratamento com atropina e vasopressor.
ABSTRACT Nicotine is a dangerous substance extracted from tobacco leaves. When nicotine is absorbed in excessive amounts, it can lead to respiratory failure and cardiac arrest. The commercialization of electronic cigarettes (e-cigarettes) has allowed users to directly handle e-cigarette liquid. Consequently, the risk of liquid nicotine exposure has increased. We describe our experience of managing the case of a patient who orally ingested a high concentration of liquid nicotine from e-cigarette liquid. The patient presented with bradycardia and hypotension, which are symptoms of parasympathetic stimulation, together with impaired consciousness. He recovered following treatment with atropine and a vasopressor.
Asunto(s)
Humanos , Masculino , Bradicardia/etiología , Sistemas Electrónicos de Liberación de Nicotina , Nicotina/envenenamiento , Atropina/uso terapéutico , Vasoconstrictores/uso terapéutico , Bradicardia/tratamiento farmacológico , Hipotensión/etiología , Hipotensión/tratamiento farmacológico , Persona de Mediana EdadRESUMEN
Abstract This is a case of bilateral and simultaneous Acremonium keratitis related to intermittent and alternating eye soft contact lens use, which has a delayed diagnose, presented amphotericin B resistance with persistent hypopyon and had a positive response to topical natamycin. Besides the unusual presentation, there was no history of trauma or contact with vegetable matter, usually associated to the majority of cases of keratomicosys by filamentous fungi.
Resumo Trata-se de um caso de ceratite bilateral e simultânea por Acremonium relacionada ao uso intermitente e sem respeitar a lateralidade do uso de lentes de contato gelatinosas. Houve diagnóstico tardio, apresentando resistência a anfotericina B e hipópio persistente, com resposta positiva a natamicina tópica. Além da forma incomum de apresentação, não houve histórico de trauma ou contato com material vegetal, associado à maioria dos casos de ceratite por fungos filamentosos.
Asunto(s)
Humanos , Femenino , Anciano , Infecciones Fúngicas del Ojo/etiología , Infecciones Fúngicas del Ojo/microbiología , Lentes de Contacto/efectos adversos , Queratitis/etiología , Queratitis/microbiología , Atropina/uso terapéutico , Acremonium/aislamiento & purificación , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/terapia , Anfotericina B/uso terapéutico , Natamicina/uso terapéutico , Itraconazol/uso terapéutico , Hifa , Farmacorresistencia Fúngica , Microscopía con Lámpara de Hendidura , Queratitis/diagnóstico , Queratitis/terapiaRESUMEN
OBJECTIVES: to evaluate and indicate the procedure to be followed in the health unit, both for diagnosis and the treatment of acute exogenous intoxications by carbamates or organophosphates. METHODS: a descriptive study based on retrospective analysis of the clinical history of patients diagnosed with intoxication by carbamates or organophosphates admitted at the emergency unit of the Hospital de Urgências de Sergipe Governador João Alves (HUSE) between January and December of 2012. Some criteria were evaluated, such as: intoxicating agent; patient's age and gender; place of event, cause, circumstances and severity of the intoxication; as well as signs and symptoms of the muscarinic, nicotinic and neurological effects. RESULTS: seventy patients (average age: 25 ± 19.97) formed the study's population. It was observed that 77.14% of them suffered carbamate intoxication. However, organophosphate intoxications were more severe, with 68.75% of patients presenting moderate to severe forms. Suicide attempt was the leading cause of poisoning, with 62 cases (88.57% of total). Atropine administration was an effective therapeutic approach for treating signs and symptoms, which included sialorrhea (p = 0.0006), nausea (p = 0. 0029) and emesis (p < 0.0001). The use of activated charcoal was shown effective, both in combating the signs and symptoms presented by both patient groups (p < 0.0001). CONCLUSION: it is concluded that the use of atropine and activated charcoal is highly effective to treat the signs and symptoms developed by patients presenting acute exogenous intoxication by carbamates or organophosphates.
Asunto(s)
Carbamatos/envenenamiento , Intoxicación por Organofosfatos/tratamiento farmacológico , Adolescente , Adulto , Anciano , Atropina/administración & dosificación , Atropina/uso terapéutico , Brasil/epidemiología , Carbón Orgánico/administración & dosificación , Carbón Orgánico/uso terapéutico , Niño , Preescolar , Antagonistas Colinérgicos/administración & dosificación , Antagonistas Colinérgicos/uso terapéutico , Servicio de Urgencia en Hospital , Femenino , Lavado Gástrico/normas , Humanos , Lactante , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Intoxicación por Organofosfatos/epidemiología , Estudios Retrospectivos , Intento de Suicidio/estadística & datos numéricos , Adulto JovenRESUMEN
Summary Objectives: to evaluate and indicate the procedure to be followed in the health unit, both for diagnosis and the treatment of acute exogenous intoxications by carbamates or organophosphates. Methods: a descriptive study based on retrospective analysis of the clinical history of patients diagnosed with intoxication by carbamates or organophosphates admitted at the emergency unit of the Hospital de Urgências de Sergipe Governador João Alves (HUSE) between January and December of 2012. Some criteria were evaluated, such as: intoxicating agent; patient's age and gender; place of event, cause, circumstances and severity of the intoxication; as well as signs and symptoms of the muscarinic, nicotinic and neurological effects. Results: seventy patients (average age: 25±19.97) formed the study's population. It was observed that 77.14% of them suffered carbamate intoxication. However, organophosphate intoxications were more severe, with 68.75% of patients presenting moderate to severe forms. Suicide attempt was the leading cause of poisoning, with 62 cases (88.57% of total). Atropine administration was an effective therapeutic approach for treating signs and symptoms, which included sialorrhea (p=0.0006), nausea (p=0. 0029) and emesis (p lt0.0001). The use of activated charcoal was shown effective, both in combating the signs and symptoms presented by both patient groups (p <0.0001). Conclusion: it is concluded that the use of atropine and activated charcoal is highly effective to treat the signs and symptoms developed by patients presenting acute exogenous intoxication by carbamates or organophosphates.
Resumo Objetivo: avaliar e indicar os procedimentos a serem seguidos na unidade de saúde tanto para o diagnóstico como para o tratamento de intoxicações agudas exógenas por carbamatos ou organofosforados. Métodos: estudo descritivo baseado na análise retrospectiva da história clínica de pacientes diagnosticados com intoxicação por carbamatos ou organofosforados admitidos em uma unidade de emergência, entre janeiro e dezembro de 2012. Foram avaliados alguns critérios, como: agente intoxicador; idade do paciente e gênero; causa de envolvimento, circunstâncias e gravidade da intoxicação; sinais e sintomas dos efeitos neurológicos muscarínicos e nicotínicos. Resultados: setenta pacientes (idade média: 25±19,97 anos) formaram a população de estudo. Foi observado que 77,14% deles sofreram intoxicação por carbamatos. Os casos mais graves foram intoxicados por organofosforados, com 68,75% dos pacientes apresentando formas moderadas a graves. Tentativa de suicídio foi a causa principal de envenenamento, com 62 casos (88,57% do total). A administração de atropina foi uma medida terapêutica efetiva para tratamento de sinais e sintomas, como sialorreia (p=0,0006), náusea (p=0,0029) e êmese (p<0,0001). O uso do carvão ativado mostrou efetividade para o combate dos sinais e sintomas apresentados por pacientes em geral (p<0,0001). Conclusão: o uso de atropina e de carvão ativado é uma medida terapêutica altamente efetiva para combater os sinais e sintomas apresentados por pacientes vítimas de intoxicação aguda exógena por carbamatos ou organofosforados.
Asunto(s)
Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Adulto Joven , Carbamatos/envenenamiento , Intoxicación por Organofosfatos/tratamiento farmacológico , Atropina/administración & dosificación , Atropina/uso terapéutico , Brasil/epidemiología , Carbón Orgánico/administración & dosificación , Carbón Orgánico/uso terapéutico , Antagonistas Colinérgicos/administración & dosificación , Antagonistas Colinérgicos/uso terapéutico , Servicio de Urgencia en Hospital , Lavado Gástrico/normas , Tiempo de Internación/estadística & datos numéricos , Intoxicación por Organofosfatos/epidemiología , Estudios Retrospectivos , Intento de Suicidio/estadística & datos numéricosAsunto(s)
Bradicardia/inducido químicamente , Cardiotoxicidad/etiología , Moraceae/envenenamiento , Agonistas de Receptores Adrenérgicos beta 2/uso terapéutico , Anciano , Albuterol/uso terapéutico , Antiarrítmicos/uso terapéutico , Atropina/uso terapéutico , Bradicardia/tratamiento farmacológico , Cardiotoxicidad/tratamiento farmacológico , Electrocardiografía , Humanos , MasculinoRESUMEN
O presente estudo descreve um surto de intoxicação por triclorfon em caprinos, que receberam pela via oral, a dosagem terapêutica do princípio ativo em questão (100mg/kg), provenientes da Universidade Estadual de Maringá, campus de Umuarama, PR. Cinquenta e três ovinos foram tratados com a mesma formulação/solução e não se observou nenhum efeito colateral nos animais referente ao tratamento com triclorfon. Das 20 cabras medicadas, cerca de 40 minutos após a administração do triclorfon, oito apresentaram os clássicos sinais clínicos de ataxia, decúbito externo-lateral, sialorreia, tremores, constrição das pupilas, dispneia com ruídos, micção e defecação involuntária, paresia espástica, timpanismo e lacrimejamento. Quase que imediatamente após a detecção destes sinais, as oito cabras foram medicadas com sulfato de atropina 1% 0,5mg/kg mais fluidoterapia. Cinco destes animais tiveram de receber nova dosagem de sulfato de atropina uma hora após a primeira aplicação, em função de alguns sinais clínicos, como tremores musculares, ainda estarem presentes. De 48 a 72 horas após a administração do triclorfon, três destes cinco animais vieram a óbito. Na necropsia, foi possível observar mucosas cianóticas, congestão de fígado, baço e rins, vasos mesentéricos congestos, vesícula biliar repleta, enfisema pulmonar, parênquima pulmonar avermelhado. Os resultados encontrados neste trabalho chamam atenção que o surto aconteceu em cabras adultas, que apresentavam boas condições clínicas e acima de tudo, receberam a dosagem terapêutica recomendada em bula pelo fabricante. Talvez isso possa indicar alguma sensibilidade mais elevada desta espécie animal à dosagem recomendada em bula do triclorfon (100mg/kg) para caprinos.
The present study describes an outbreak of trichlorfon poisoning in goats from the State University of Maringá, campus Umuarama/PR that received orally the therapeutic dose of the active ingredient in question (100mg/kg). Fifty-three sheep had been treated with the same formulation/solution and no side effects were observed in any of these sheep medicated with triclorfon. But from 20 goats medicated with trichlorfon, eight goats showed, about 40 minutes after its administration, the classic clinical signs of ataxia, external lateral decubitus, drooling, tremors, constricted pupils, noisy dyspnea, involuntary urination and defecation, spastic paresis, bloat and tearing. Almost immediately after the detection of these signals, eight goats were medicated with 1% atropine sulfate (0.5mg/kg and fluid). Five of these goats received a second dose of atropine sulfate one hour after the first application because of some clinical signs such as muscle tremor still being present. Forty-eight to 72 hours after administration of trichlorfon, three of those five goats died. At necropsy we observed cyanotic mucous membranes, congestion of liver, spleen, kidneys and mesenteric vessels, filled gallbladder, emphysema, and reddish lungs. The results of this study call attention to the outbreak that occurred in adult goats in good clinical conditions and, above all, that they received the therapeutic dosage recommended on the manufacture label. This suggests a higher sensitivity of the species to the recommended dose of trichlorfon (100mg/kg) for goats.
Asunto(s)
Animales , Insecticidas Organofosforados/efectos adversos , Intoxicación por Organofosfatos/veterinaria , Ovinos , Triclorfón/efectos adversos , Ataxia/veterinaria , Atropina/uso terapéuticoRESUMEN
O presente estudo descreve um surto de intoxicação por triclorfon em caprinos, que receberam pela via oral, a dosagem terapêutica do princípio ativo em questão (100mg/kg), provenientes da Universidade Estadual de Maringá, campus de Umuarama, PR. Cinquenta e três ovinos foram tratados com a mesma formulação/solução e não se observou nenhum efeito colateral nos animais referente ao tratamento com triclorfon. Das 20 cabras medicadas, cerca de 40 minutos após a administração do triclorfon, oito apresentaram os clássicos sinais clínicos de ataxia, decúbito externo-lateral, sialorreia, tremores, constrição das pupilas, dispneia com ruídos, micção e defecação involuntária, paresia espástica, timpanismo e lacrimejamento. Quase que imediatamente após a detecção destes sinais, as oito cabras foram medicadas com sulfato de atropina 1% 0,5mg/kg mais fluidoterapia. Cinco destes animais tiveram de receber nova dosagem de sulfato de atropina uma hora após a primeira aplicação, em função de alguns sinais clínicos, como tremores musculares, ainda estarem presentes. De 48 a 72 horas após a administração do triclorfon, três destes cinco animais vieram a óbito. Na necropsia, foi possível observar mucosas cianóticas, congestão de fígado, baço e rins, vasos mesentéricos congestos, vesícula biliar repleta, enfisema pulmonar, parênquima pulmonar avermelhado. Os resultados encontrados neste trabalho chamam atenção que o surto aconteceu em cabras adultas, que apresentavam boas condições clínicas e acima de tudo, receberam a dosagem terapêutica recomendada em bula pelo fabricante. Talvez isso possa indicar alguma sensibilidade mais elevada desta espécie animal à dosagem recomendada em bula do triclorfon (100mg/kg) para caprinos.(AU)
The present study describes an outbreak of trichlorfon poisoning in goats from the State University of Maringá, campus Umuarama/PR that received orally the therapeutic dose of the active ingredient in question (100mg/kg). Fifty-three sheep had been treated with the same formulation/solution and no side effects were observed in any of these sheep medicated with triclorfon. But from 20 goats medicated with trichlorfon, eight goats showed, about 40 minutes after its administration, the classic clinical signs of ataxia, external lateral decubitus, drooling, tremors, constricted pupils, noisy dyspnea, involuntary urination and defecation, spastic paresis, bloat and tearing. Almost immediately after the detection of these signals, eight goats were medicated with 1% atropine sulfate (0.5mg/kg and fluid). Five of these goats received a second dose of atropine sulfate one hour after the first application because of some clinical signs such as muscle tremor still being present. Forty-eight to 72 hours after administration of trichlorfon, three of those five goats died. At necropsy we observed cyanotic mucous membranes, congestion of liver, spleen, kidneys and mesenteric vessels, filled gallbladder, emphysema, and reddish lungs. The results of this study call attention to the outbreak that occurred in adult goats in good clinical conditions and, above all, that they received the therapeutic dosage recommended on the manufacture label. This suggests a higher sensitivity of the species to the recommended dose of trichlorfon (100mg/kg) for goats.(AU)
Asunto(s)
Animales , Ovinos , Triclorfón/efectos adversos , Insecticidas Organofosforados/efectos adversos , Intoxicación por Organofosfatos/veterinaria , Ataxia/veterinaria , Atropina/uso terapéuticoRESUMEN
Este relato aborda um caso atípico de úlcera de córnea em uma criança de 09 anos, causado pela bactéria Pseudomonas stutzeri, um micro-organismo oportunista cujo isolamento em olhos é extremamente raro.
This report discusses an unusual case of corneal ulcer in a child of 09 years old, caused by the bacteria Pseudomonas stutzeri, an opportunistic organism whose isolation in the eyes is extremely rare.