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OBJECTIVES: To assess the relative frequency and associated factors of disorders of gut-brain interaction (DGBIs) in outpatient gastrointestinal (GI) clinics in young children of Latin America. METHODS: Cross-sectional study in 10 pediatric GI outpatient clinics (private and public) in five countries of Latin America (El Salvador, México, Colombia, Panamá, and Nicaragua). Parents of patients 1 month 4 years of age from outpatient clinics complete/d a diagnostic questionnaire for DGBIs per Rome IV criteria (QPGS-IV, Spanish version). We conducted descriptive analysis, two-sample t-tests and chi-square tests, univariate analyses, and logistic regression to evaluate risk factors. RESULTS: We collected data from 783 children. In total, 34.5% had a DGBI. Overall, functional constipation (FC) was the most common diagnosis (23.4%) in children of all ages (infants, 16.1%, 1-4-years-old, 32.7%). In infants, the second most common DGBI was regurgitation (6.6%) and in 1-4-years-old and cyclic vomiting syndrome (4.1%). The diagnosis of a DGBI was significantly associated with a family history of DGBIs (odds ratio [OR] 2.97, 95% confidence interval [CI] 1.61-5.57, p = 0.0001). Patients who identified as black (OR 2.25, 95% CI 1.28-3.92, p = 0.0021) or mixed race (OR 1.76, 95% CI 1.25-2.48, p = 0.0006) were also significantly associated with a higher likelihood of DGBIs. CONCLUSIONS: DGBIs are a common diagnosis in pediatric GI clinics of Latin America. Overall, FC was the most common DGBI.
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Enfermedades Gastrointestinales , Humanos , Lactante , Estudios Transversales , Masculino , Preescolar , Femenino , América Latina/epidemiología , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/epidemiología , Eje Cerebro-Intestino , Estreñimiento/diagnóstico , Estreñimiento/epidemiología , Encuestas y Cuestionarios , Factores de Riesgo , Gastroenterología/estadística & datos numéricos , Modelos Logísticos , Vómitos/diagnóstico , Vómitos/epidemiologíaRESUMEN
Cyclic vomiting syndrome (CVS) is a disorder characterized by recurrent and unpredictable episodes of intense vomiting, interspersed with periods of apparent wellbeing. This disorder, which primarily affects children and adolescents but can persist into adulthood, has recently been the subject of extensive study and analysis in the medical literature. The aim of the present review is to examine the most important aspects of the epidemiology, pathophysiology, subtypes, diagnostic criteria, and current management of CVS. Even though the exact etiology remains unknown, genetic factors (polymorphisms), nervous system alterations and autonomic dysregulation, and environmental factors (use and abuse of cannabinoids) are postulated as possible triggers. CVS has significant diagnostic challenges, given that there is no specific test for confirming its presence. Thorough evaluation of symptoms and the ruling out of other possible causes of recurrent vomiting are required. Management of CVS typically involves a multidisciplinary approach. Pharmacologic options are explored, such as antiemetics and preventive medications, as well as behavioral and psychologic support therapies. Treatment personalization is essential, adapting it to the individual needs of each patient. Despite advances in the understanding of CVS, it remains a significant clinical challenge. This disorder impacts the quality of life of those affected and their families, underscoring the ongoing need for research and the development of more effective treatment strategies.
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Vómitos , Humanos , Vómitos/terapia , Vómitos/etiología , Vómitos/fisiopatologíaRESUMEN
Superior mesenteric artery syndrome (SMAS) is a rare cause of duodenal obstruction which is characterized by compression of the duodenum due to narrowing of the space between the superior mesenteric artery and aorta. Incomplete duodenal obstruction due to SMAS in neonates is rarely reported in the literature. In this case, it is a full-term 2-day-old male with the complaint of recurrent vomiting starting soon after birth. The patient was diagnosed with SMAS and duodenoduodenostomy was performed. Accompanying Meckel's diverticulum was excised.
El síndrome de la arteria mesentérica superior (SMAS) es una causa rara de obstrucción duodenal que se caracteriza por la compresión del duodeno debido al estrechamiento del espacio entre la arteria mesentérica superior y la aorta. La obstrucción duodenal incompleta por SMAS en recién nacidos rara vez se informa en la literatura. En este caso se trata de un varón de 2 días nacido a término que presenta vómitos recurrentes desde poco después del nacimiento. El paciente fue diagnosticado de SMAS y se le realizó duodenoduodenostomía. Se extirpó el divertículo de Meckel que lo acompañaba.
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Duodenostomía , Divertículo Ileal , Síndrome de la Arteria Mesentérica Superior , Humanos , Divertículo Ileal/complicaciones , Divertículo Ileal/cirugía , Síndrome de la Arteria Mesentérica Superior/complicaciones , Síndrome de la Arteria Mesentérica Superior/cirugía , Síndrome de la Arteria Mesentérica Superior/diagnóstico por imagen , Masculino , Recién Nacido , Obstrucción Duodenal/etiología , Obstrucción Duodenal/cirugía , Vómitos/etiologíaRESUMEN
OBJECTIVE: Ayahuasca, an entheogen from the Amazon rainforest, has garnered growing interest for treating substance dependence. To date, there is little research concerning the act of ayahuasca-related purging (mainly vomiting), which is considered to be central to healing during ayahuasca rituals. This study explored practitioner perspectives on purging during ayahuasca rituals at the Takiwasi Center in Peru. METHOD: We conducted in-depth interviews with curanderos (healers), plant preparers, and psychotherapists (N = 11) at the Takiwasi Center between August and October 2021. Interviews were conducted and transcribed in Spanish. Interviews were analyzed using a thematic analysis approach. RESULTS: Participants described purging as a fluid concept that went beyond the act of vomiting. Participant narratives around purging were organized into three central themes or accounts: spiritual-oriented, which highlighted the relationship between purging and spiritual development; Amazonian-oriented, which emphasized purging as a cathartic expulsion of embodied cargas (loads) that are perceived to lead to sickness; and clinical-oriented, which stressed that purging generates a range of empirically observable therapeutic benefits. All of these explanatory models emphasized the pivotal interconnection between purging and healing during ayahuasca-assisted treatment for substance dependence at Takiwasi. CONCLUSIONS: This study highlights practitioner perspectives on purging at the Takiwasi Center, who offer three main explanatory models for this aspect of healing during ayahuasca-assisted therapy for substance dependence. This research contributes to the limited literature on the role of purging in ayahuasca-related healing, which may inform further investigation into differential understandings of the role of purging for therapeutic benefits.
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Banisteriopsis , Conducta Ceremonial , Investigación Cualitativa , Trastornos Relacionados con Sustancias , Humanos , Perú , Femenino , Masculino , Trastornos Relacionados con Sustancias/tratamiento farmacológico , Adulto , Centros de Tratamiento de Abuso de Sustancias , Vómitos/inducido químicamente , Vómitos/tratamiento farmacológico , Persona de Mediana EdadRESUMEN
OBJECTIVE: Anticipatory nausea and vomiting are unpleasant symptoms observed before undergoing chemotherapy sessions. Less is known about the occurrence of symptoms since the advent of the new neurokinin-1 antagonist. METHODS: This prospective cohort study was performed at a single Brazilian Institution. This study included breast cancer patients who received doxorubicin and cyclophosphamide chemotherapy and an appropriate antiemetic regimen (dexamethasone 10 mg, palonosetron 0.56 mg, and netupitant 300 mg in the D1 followed by dexamethasone 10 mg 12/12 h in D2 and D4). Patients used a diary to record nausea, vomiting, and use of rescue medication in the first two cycles of treatment. The prevalence of anticipatory nausea and vomiting was assessed before chemotherapy on day 1 of C2. RESULTS: From August 4, 2020, to August 12, 2021, 60 patients were screened, and 52 patients were enrolled. The mean age was 50.8 (28-69) years, most had stage III (53.8%), and most received chemotherapy with curative intent (94%). During the first cycle, the frequency of overall nausea and vomiting was 67.31%, and that of severe nausea and vomiting (defined as grade>4 on a 10-point visual scale or use of rescue medication) was 55.77%. Ten patients had anticipatory nausea and vomiting (19.23%). The occurrence of nausea and vomiting during C1 was the only statistically significant predictor of anticipatory nausea and vomiting (OR=16, 95%CI 2.4-670.9, p=0.0003). CONCLUSION: The prevalence of anticipatory nausea is still high in the era of neurokinin-1 antagonists, and failure of antiemetic control in C1 remains the main risk factor. All efforts should be made to control chemotherapy-induced nausea or nausea and vomiting on C1 to avoid anticipatory nausea.
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Antieméticos , Neoplasias de la Mama , Náusea , Humanos , Femenino , Neoplasias de la Mama/tratamiento farmacológico , Persona de Mediana Edad , Estudios Prospectivos , Adulto , Antieméticos/uso terapéutico , Anciano , Náusea/inducido químicamente , Prevalencia , Brasil/epidemiología , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Ciclofosfamida/efectos adversos , Ciclofosfamida/uso terapéutico , Doxorrubicina/efectos adversos , Vómito Precoz , Vómitos/inducido químicamente , Vómitos/epidemiología , Dexametasona/uso terapéutico , Palonosetrón/uso terapéuticoRESUMEN
Gastrointestinal symptoms and problems (GI- SP) frequently cause discomfort and suffering in pediatric patients with life-threatening and/or life-limiting illnesses (LTI/LLI). Pediatric palliative care (PPC) professionals should be aware of them and perform a comprehensive approach. OBJECTIVE: To determine the prevalence of GI- SP in patients treated in PPC units and to describe the pharmacological and non-pharmacological measures prescribed. PATIENTS AND METHOD: Observational, prospective, multicenter, prospective study in patients with LTI/LLI, seen by PPC teams in Uruguay. The variables analyzed included age, sex, origin, type of LTI/LLI, presence of mucositis, vomiting, swallowing disorders, abdominal pain, constipation, diarrhea, digestive bleeding, problems with digestive prosthesis, and prescribed pharmacological and non-pharmacological treatment. RESULTS: 10 out of 16 PPC teams participated. 96 out of 436 patients seen presented GI- SP (22%). Median age was 4.2 years (1 month-18 years). LTI/LLI: 65% neurological and 7% oncological. The 96 patients had 114 consultations; 50% had 2 or more GI- SP per consultation. GI- SP observed: swallowing disorders (57%), constipation (53%), nausea and/or vomiting (24%), gastrostomy problems (17%), abdominal pain (10%), digestive bleeding (3%), and diarrhea (2%). There were variable prescriptions of pharmacological and non-pharmacological measures; only 50% of those with swallowing disorder received speech and hearing therapy. CONCLUSIONS: GI- SP motivated consultations in all PPC settings, frequently due to 2 or more GI- SP. Swallowing disorders and gastrostomy complications are frequent but not very visible problems in PPC. According to the comprehensive approach, pharmacological and non-pharmacological measures were implemented.
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Trastornos de Deglución , Enfermedades Gastrointestinales , Niño , Preescolar , Humanos , Dolor Abdominal/epidemiología , Dolor Abdominal/etiología , Dolor Abdominal/terapia , Estreñimiento , Trastornos de Deglución/epidemiología , Trastornos de Deglución/etiología , Trastornos de Deglución/terapia , Diarrea/epidemiología , Diarrea/terapia , Enfermedades Gastrointestinales/epidemiología , Enfermedades Gastrointestinales/terapia , Cuidados Paliativos , Estudios Prospectivos , Vómitos/epidemiología , Vómitos/etiología , Vómitos/terapia , Masculino , Femenino , Lactante , AdolescenteRESUMEN
OBJECTIVE: To identify clinical characteristics that distinguish cannabinoid hyperemesis syndrome (CHS) from cyclic vomiting syndrome (CVS), 2 conditions marked by episodes of nausea, vomiting, and abdominal pain. STUDY DESIGN: We performed a retrospective chart review of patients admitted to a large children's health care system from 2015 through 2022. Patients with CHS and CVS were identified by the electronic medical record using International Classification of Diseases, Ninth and Tenth Revision codes. RESULTS: Of 201 patients screened, 125 were included. Patients with CHS were older than those with CVS (mean [SD] 18.06 [1.41] vs 14.50 [2.91] years, P < .001). There were no significant differences in sex, race, ethnicity, or hospital length of stay between groups. Patients with CHS were more likely to have a positive urine drug screen (86% vs 2.9%, P < .001), lower mean (SD) serum potassium (3.62 [0.77] vs 3.88 [0.49], P < .001), and greater mean (SD) serum creatinine (0.83 (0.41) vs 0.63 (0.17), P < .001). The average (SD) systolic blood pressure was significantly greater in patients with CHS (systolic blood pressure 124.46 [10.66] vs 118.55 [10.99], P = .032) compared with children of comparable age range with CVS. Imaging was obtained in 36% of all patients, and only 2.4% had abnormalities. CONCLUSIONS: Clinical features including older age, greater systolic blood pressure, positive urine drug screen, and select electrolyte findings might distinguish CHS from CVS. Abdominal imaging in both conditions is of low yield. These findings may allow for early recognition and appropriate therapy in CHS patients.
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Síndrome de Hiperemesis Cannabinoide , Vómitos , Adolescente , Niño , Femenino , Humanos , Masculino , Síndrome de Hiperemesis Cannabinoide/diagnóstico , Cannabinoides/efectos adversos , Diagnóstico Diferencial , Náusea/inducido químicamente , Estudios Retrospectivos , Vómitos/inducido químicamente , Vómitos/diagnósticoRESUMEN
OBJECTIVE: To evaluate the effect of ginger with P6 acupressure in preventing and treating chemotherapy-induced nausea and vomiting (CINV) in cancer patients. METHOD: A total of 172 participants were randomly divided into the control, ginger, acupressure, and joint groups, who were hospitalized in the Affiliated Hospital of Xuzhou Medical University from February and September 2022. The baseline characteristics, nausea, vomiting, and retching, benefit finding, functional living index-emesis, treatment satisfaction, and adverse reaction, were used in data collection. RESULTS: No significant difference was found in benefit finding and adverse reactions among the four groups (P > 0.05). Ginger significantly improved delayed CINV and function living index-nausea (P < 0.05) but had no significant effect on acute CINV, retching, and delayed vomiting, functional living index-emesis, and treatment satisfaction (P>0.05). Acute nausea and retching, delayed nausea, vomiting, and retching, functional living index-emesis, and treatment satisfaction were effectively improved in the acupressure and joint groups (P < 0.05). CONCLUSION: Ginger with P6 acupressure may contribute to improving CINV in patients undergoing chemotherapy.
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Acupresión , Antineoplásicos , Zingiber officinale , Humanos , Náusea/inducido químicamente , Náusea/tratamiento farmacológico , Náusea/prevención & control , Vómitos/inducido químicamente , Vómitos/tratamiento farmacológico , Vómitos/prevención & control , Antineoplásicos/efectos adversosRESUMEN
BACKGROUND: Pregnancy induces physiological changes, commonly marked by nausea and vomiting in the first trimester, posing risks for both mother and baby. This study evaluates the effects of auriculotherapy on nausea and vomiting during the first trimester of pregnancy. MATERIALS AND METHODS: A randomized clinical trial was conducted in two primary health care centers with 56 Brazilian pregnant women who reported nausea or vomiting in the first trimester. The participants were divided into an intervention group (auriculotherapy with seeds) and a placebo group (sham auriculotherapy). The intervention was divided into three moments: pre-intervention with assessment of nausea and vomiting and application of questionnaires, and two follow-ups conducted on the fourth and seventh day of the intervention, with reassessment of nausea and vomiting. RESULTS: Both groups experienced a decrease in nausea and vomiting over time, with no statistically significant differences between groups in the within-group analyses at various time points. The intervention group had a greater reduction in symptoms. Within the intervention group, symptoms were more common among ferrous sulfate users and those without reported dietary disturbances. In addition, a higher incidence of nausea and vomiting was associated with the use of analgesics, morning snacks, and low intake of protein, vegetables, and fruits. CONCLUSIONS: The intervention did not affect the between-group differences in the incidence of nausea and vomiting and vomiting effort in the first trimester of pregnancy. However, a greater reduction was observed in the intervention group.
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Auriculoterapia , Complicaciones del Embarazo , Femenino , Embarazo , Humanos , Mujeres Embarazadas , Resultado del Tratamiento , Vómitos/terapia , Náusea/terapia , Complicaciones del Embarazo/terapiaRESUMEN
Introducción: Dentro de las causas poco frecuentes de oclusión intestinal se encuentra el vólvulo de intestino delgado, el cual consiste en una torsión anormal del intestino alrededor del su propio eje de mesenterio, que provoca una obstrucción mecánica del intestino. Objetivo: Describir la semiografía del vólvulo de intestino delgado en un paciente de edad avanzada. Caso clínico: Paciente masculino de 62 años de edad, que ingresa en el cuerpo de guardia de cirugía, por dolor abdominal, tipo cólico intermitente, con una evolución de 72 horas; además, presenta distensión abdominal, náuseas y vómitos. Con el cuadro clínico, más los exámenes complementarios, se constata oclusión intestinal mecánica, causada por un vólvulo del intestino delgado. A los 5 días de ser intervenido quirúrgicamente se complicó por una perforación intestinal debido a necrosis del asa. Conclusiones: Debido a su presentación atípica y sus graves complicaciones, se precisa un diagnóstico certero y tratamiento urgente al paciente con vólvulo del intestino delgado, ya que pone en riesgo la vida(AU)
Introduction: Among the rare causes of intestinal obstruction is small intestine volvulus, which consists of an abnormal twisting of the intestine around its own mesentery axis, which causes a mechanical obstruction of the intestine. Objective: To describe the semiography of small intestine volvulus in an elderly patient. Clinical case: 62-year-old male patient, admitted to the surgery ward, due to abdominal pain, intermittent colic type, with an evolution of 72 hours; In addition, he presents abdominal distention, nausea and vomiting. With the clinical picture, plus complementary examinations, mechanical intestinal occlusion is confirmed, caused by a volvulus of the small intestine. Five days after undergoing surgery, it was complicated by intestinal perforation due to necrosis of the loop. Conclusions: Due to its atypical presentation and serious complications, an accurate diagnosis and urgent treatment are required for patients with small intestine volvulus, since it puts life at risk(AU)
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Humanos , Masculino , Persona de Mediana Edad , Vólvulo Intestinal/cirugía , Obstrucción Intestinal/cirugía , Perforación Intestinal/complicaciones , Intestino Delgado/cirugía , Necrosis/etiología , Vómitos , Dolor Abdominal/complicaciones , Cólico/diagnóstico , NáuseaRESUMEN
Introducción: La enfermedad descompresiva es un síndrome clínico complejo causado por la sobresaturación de gases respiratorios en la sangre y los tejidos, después de una reducción abrupta de la presión ambiental, que puede presentarse como parte de los accidentes de buceo. Dada su baja prevalencia se da a conocer una de sus formas de presentación en los servicios de urgencias, que requiere rapidez en el diagnóstico y conducta terapéutica inmediata. Objetivo: Presentar un caso grave de enfermedad descompresiva del oído interno. Caso clínico: Paciente masculino de 71 años de edad, buzo aficionado y antecedente de un accidente vascular encefálico isquémico hace aproximadamente 1 año. Realizó inmersiones, luego de las cuales comenzó a presentar síntomas como mareos, náuseas, vómitos copiosos, inestabilidad para la marcha y manifestaciones sensitivas en la cara. Horas después de ser evaluado en centro médico de urgencia, sin diagnóstico específico, se trasladó al cuerpo de guardia del hospital, para su valoración por el especialista en medicina subacuática. Conclusiones: La orientación diagnóstica de un paciente con enfermedad descompresiva requiere derivación urgente a un centro de tratamiento de enfermedades disbáricas(AU)
Introduction: Decompression illness is a complex clinical syndrome caused by supersaturation of respiratory gases in the blood and tissues, after an abrupt reduction in environmental pressure, which can occur as part of diving accidents. Given its low prevalence, one of its forms of presentation is revealed in emergency services, which requires speed in diagnosis and immediate therapeutic conduct. Objective: To present a severe case of decompressive disease of the inner ear. Clinical case: 71-year-old male patient, amateur diver, with a history of an ischemic stroke approximately 1 year ago. He performed dives, after which he began to present symptoms such as dizziness, nausea, copious vomiting, unsteadiness in walking, and sensitive manifestations on the face. Hours after being evaluated at the emergency medical center, without a specific diagnosis, he was transferred to the hospital's emergency room, for evaluation by the underwater medicine specialist. Conclusions: The diagnostic orientation of a patient with decompression illness requires urgent referral to a center for the treatment of dysbaric diseases(AU)
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Humanos , Masculino , Anciano , Buceo , Accidente Cerebrovascular Isquémico , Oxigenoterapia Hiperbárica/métodos , Enfermedades del Laberinto/diagnóstico , Enfermedades del Laberinto/terapia , Vómitos , Mareo , Urgencias Médicas , Marcha , Inmersión , NáuseaRESUMEN
BACKGROUND: Natural and synthetic cannabinoids are being used worldwide to treat various symptoms in cancer patients. This study aims to map the therapeutic benefits and adverse effects associated with the use of cannabis-based drugs in these outcomes. METHODS: Following Joanna Briggs Institute guidelines a scoping review was conducted. The study protocol was available in the Open Science Framework public repository. An extensive search strategy involving databases like Cochrane Library, Embase, CINAHL, Medline/PubMed, Lilacs, Google Scholar, and Open Gray for gray literature analysis was executed by a skilled librarian. The inclusion criteria were primary studies (observational and randomized) that evaluated the efficacy and safety of cannabinoids in cancer patients. The review encompassed studies of diverse designs, publication years, and types, as long as they addressed cannabinoids' impact in oncology. RESULTS: Twenty-nine (82.86%) out of total of 35 were randomized and 6 (14.14%) were non-randomized. About 57.1% of studies utilized registered products as interventions, with THC being the most natural cannabinoid cited in variable doses and administration routes. Moreover, 62.85% of studies specified the cancer types (breast, lung, sarcomas, hematological and reproductive system), while only one study detailed cancer staging. The evaluated outcomes encompassed nausea and vomiting (77.14%), appetite (11.43%), pain (8.57%), and tumor regression (2.86%) across different proportions of studies. CONCLUSION: Cannabinoids show promise in managing pain, emesis, and anorexia/cachexia linked to cancer progression. New randomized clinical trials with a larger number of participants and observational studies on long-term safety are crucial to affirm their medicinal utility for cancer patients unresponsive to conventional drugs.
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Cannabinoides , Marihuana Medicinal , Neoplasias , Humanos , Marihuana Medicinal/uso terapéutico , Marihuana Medicinal/efectos adversos , Neoplasias/tratamiento farmacológico , Cannabinoides/uso terapéutico , Cannabinoides/efectos adversos , Vómitos/inducido químicamente , Ensayos Clínicos Controlados Aleatorios como Asunto , Náusea/inducido químicamenteRESUMEN
This study evaluated clinical features of individuals with long COVID (5-8 months after diagnosis) who reported sleep and memory problems (62 cases) compared to those without (52 controls). Both groups had a similar mean age (41 vs. 39 years). Around 86% of the participants were non-hospitalized at the time of infection, and none of them were vaccinated at that point. Subsequently, both cases and controls received the vaccine; however, the vaccination rates differed significantly between the groups (30.7% vs. 51.0%). Cases and controls had similar rates of symptoms at acute COVID phase. However, cases were more likely to experience coryza, dyspnea, headache, and nausea/vomiting during long COVID. Regarding new-onset symptoms in long COVID, 12.9% of cases had dyspnea, and 14.5% experienced nausea/vomiting, whereas in the control group there were only 1.9% and 0.0%, respectively. Cases also had a significantly higher prevalence of persistent headache (22.6% vs. 7.7%), and dyspnea (12.9% vs. 0.0). In addition, cases also showed an increased rate of mental health complaints: disability in daily activities (45.2% vs. 9.6%; P < 0.001); concentration/sustained attention difficulties (74.2% vs. 9.6%; P < 0.001); anxiety-Generalized Anxiety Disorder 2-item scale (GAD-2) ≥ 3 (66.1% vs. 34.6%; P = 0.0013); and "post-COVID sadness" (82.3% vs. 40.4%; P < 0.001). We observed a significant correlation between sadness and anxiety in cases, which was not observed in controls (P=0.0212; Spearman correlation test). Furthermore, the frequency of concomitant sadness and anxiety was markedly higher in cases compared to controls (59.7% vs. 19.2%) (P < 0.0001; Mann-Whitney test). These findings highlight a noteworthy association between sadness and anxiety specifically in cases. In conclusion, our data identified concurrent psychological phenotypes in individuals experiencing sleep and memory disturbances during long COVID. This strengthens the existing evidence that SARS-CoV-2 causes widespread brain pathology with interconnected phenotypic clusters. This finding highlights the need for comprehensive medical attention to address these complex issues, as well as major investments in testing strategies capable of preventing the development of long COVID sequelae, such as vaccination.
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COVID-19 , SARS-CoV-2 , Humanos , COVID-19/epidemiología , Síndrome Post Agudo de COVID-19 , Depresión/epidemiología , Sueño , Cefalea/epidemiología , Disnea , Náusea , VómitosRESUMEN
BACKGROUND Superior semicircular canal dehiscence is an inner-ear pathology which presents with vertigo, disequilibrium, and hearing loss. Although the exact etiology of superior semicircular canal dehiscence is unknown, it is thought that an increase in middle-ear pressure disrupts a thin overlying temporal bone. Superior semicircular canal dehiscence is frequently seen in association with dehiscence of the tegmen tympani, which overlies the middle ear. Here, we present a case report of a 52-year-old Puerto Rican man with vertigo, dizziness, vomiting, and mild hearing loss associated with superior semicircular canal and tegmen tympani dehiscence after performing improper scuba diving techniques. CASE REPORT A 52-year-old Puerto Rican man presented to the emergency department with vertigo, dizziness, vomiting, and mild hearing loss in the right ear. The symptoms began shortly after scuba diving with inadequate decompression techniques on ascent. He was treated with recompression therapy with mild but incomplete improvement in symptoms. Bilateral temporal magnetic resonance imaging was suggestive of segmental dehiscence of the right superior semicircular canal and tegmen tympani. High-resolution computed tomography of the temporal bone confirmed right superior semicircular canal and tegmen tympani dehiscence with an intact left inner ear. CONCLUSIONS The increased inner-ear pressure that occurs during scuba diving can lead to dehiscence of the superior semicircular canal and tegmen tympani, causing vertigo and hearing loss. Performance of improper diving techniques can further increase the risk of dehiscence. Therefore, appropriate radiologic evaluation of the inner ear should be performed in such patients.
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Buceo , Pérdida Auditiva , Dehiscencia del Canal Semicircular , Masculino , Humanos , Persona de Mediana Edad , Mareo/complicaciones , Mareo/patología , Dehiscencia del Canal Semicircular/complicaciones , Dehiscencia del Canal Semicircular/patología , Buceo/efectos adversos , Canales Semicirculares/diagnóstico por imagen , Oído Medio/diagnóstico por imagen , Vértigo/etiología , Vértigo/patología , Pérdida Auditiva/complicaciones , Pérdida Auditiva/patología , VómitosRESUMEN
INTRODUCTION: Despite preventive strategies, vomiting is an adverse event affecting patients with cancer. However, literature on the incidence and risk factors for vomiting in pediatric patients with cancer are scarce. AIM: To assess the incidence and risk factors for vomiting within 24 h and goodness of fit for the Eberhart score in pediatric patients with hematologic cancers after receiving intrathecal chemotherapy under deep sedation. METHODS: This prospective cohort study included patients under 20 years of age with hematologic cancers who were scheduled to undergo intrathecal chemotherapy under anesthesia. The primary outcome was the occurrence of vomiting within 24 h after the end of anesthesia. Sociodemographic and procedure data and underlying diseases were collected. Patients were monitored during the procedure, in the postanesthesia care unit, and the day after (by phone call). RESULTS: A total of 139 patients were included, and the incidence of vomiting was 30.9% within 24 h after intrathecal chemotherapy under anesthesia, with 90.7% of vomiting prior to 6 h. Prophylactic ondansetron was administered prior to the procedure to 45.3% of patients. Risk factors for vomiting were female gender (hazard ratio: 2.47, 95% confidence interval: 1.35-4.53, p: .003), consolidation phase of treatment (hazard ratio: 2.16, 95% confidence interval: 1.10-4.24, p: .025), and history of kinetosis (hazard ratio: 2.49, 95% confidence interval: 1.31-4.70, p: .005). Incidence of vomit was higher than estimated by the Eberhart score distribution (observed incidence in patients with a score of zero: 33.3%; with a score of one: 28.8%; with a score of two: 60%). CONCLUSION: A high incidence of vomiting was observed within 24 h after intrathecal chemotherapy under propofol deep sedation. Risk factors for this outcome were established (being female, consolidation phase of treatment, and previous kinetosis), and evidence suggested that the Eberhart score was not suitable for the studied population.
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Anestesia , Antieméticos , Neoplasias Hematológicas , Neoplasias , Humanos , Niño , Femenino , Masculino , Antieméticos/uso terapéutico , Estudios de Cohortes , Estudios Prospectivos , Vómitos/inducido químicamente , Vómitos/epidemiología , Ondansetrón/uso terapéutico , Neoplasias Hematológicas/tratamiento farmacológico , Neoplasias/tratamiento farmacológico , Método Doble CiegoRESUMEN
Pacientes com transtornos alimentares (TAs) são considerados mais vulneráveis ao sofrimento psíquico induzido pela pandemia de Covid-19. Este estudo teve como objetivo analisar as repercussões do isolamento social na saúde física e mental de pacientes com diagnóstico de TAs durante o primeiro ano da pandemia de Covid-19 e investigar suas reações à mudança do atendimento presencial para o online. Trata-se de uma pesquisa qualitativa, descritiva e exploratória, com delineamento longitudinal. Participaram 13 pacientes do sexo feminino, com idades entre 13 e 66 anos, em seguimento ambulatorial em um serviço vinculado ao Sistema Único de Saúde (SUS). Os dados foram colhidos de forma remota, por meio de um formulário aplicado e reaplicado em um intervalo de seis meses. Os resultados foram submetidos à análise temática reflexiva e agrupados em quatro categorias centrais: adaptação às condições de isolamento social; repercussões emocionais ao escutar o persistente rumor da morte; qualidade da alimentação, gestão das emoções e nível de insatisfação corporal; e facilidades e barreiras percebidas na transição para o atendimento online. Os achados evidenciam marcada vulnerabilidade psicossocial, que se reflete na piora de sintomas preexistentes e no aparecimento de novos sofrimentos psíquicos, indicando a necessidade de intensificar o acompanhamento terapêutico no período pandêmico, de acordo com as adaptações requeridas.(AU)
Patients with eating disorders (EDs) are considered more vulnerable to pandemic-induced psychological distress due to COVID-19 pandemic. This study aimed to analyze the repercussions of social isolation on the physical and mental health of patients diagnosed with EDs during the first year of the COVID-19 pandemic and to investigate their reactions to the shift from face-to-face to online care. This is a qualitative, descriptive, and exploratory research with a longitudinal design. In total, 13 female patients aged from 13 to 66 years and who were in outpatient follow-up participated in this research. Data were remotely collected using a form applied and reapplied at a six-month interval. Results were subjected to thematic reflective analysis and grouped into four central categories: Adaptation to conditions of social isolation; Emotional repercussions: listening to the persistent rumor of death; Quality of food, management of emotions, and level of body dissatisfaction; Transition to online care: perceived facilities and barriers. Results show marked psychosocial vulnerability, which is reflected in the worsening of preexisting symptoms and the emergence of new psychological suffering, indicating the need to intensify the monitoring in this period, according to the adaptations required by the pandemic scenario.(AU)
Los pacientes con trastornos de la conducta alimentaria (TCA) están más vulnerables al sufrimiento psíquico inducido por la pandemia de la Covid-19. Este estudio tuvo como objetivo analizar las repercusiones del aislamiento social en la salud física y mental de pacientes con diagnóstico de TCA durante el primer año de la pandemia de Covid-19 e investigar sus reacciones al cambio de la atención presencial a la online. Se trata de una investigación cualitativa, descriptiva y exploratoria, con diseño longitudinal. Participaron 13 pacientes mujeres, con edades de entre 13 y 66 años, en seguimiento en un servicio vinculado al Sistema Único de Salud (SUS). Los datos se recogieron de manera remota mediante un formulario aplicado y reaplicado en un intervalo de seis meses. Los resultados se sometieron a análisis temático reflexivo y se agruparon en cuatro categorías centrales: Adaptación a las condiciones de aislamiento social; Repercusiones emocionales en la escucha del persistente rumor de la muerte; calidad de la alimentación, gestión de las emociones y nivel de insatisfacción corporal; y facilidades y obstáculos percibidos en la transición a la atención en línea. Los resultados muestran una marcada vulnerabilidad psicosocial, que se refleja en el empeoramiento de los síntomas preexistentes y en la aparición de nuevos sufrimientos psicológicos, lo que indica la necesidad de intensificar el seguimiento, de acuerdo con las adaptaciones requeridas.(AU)
Asunto(s)
Humanos , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Aislamiento Social , Trastornos de Alimentación y de la Ingestión de Alimentos , Conducta Alimentaria , Trastorno por Atracón , Pandemias , COVID-19 , Ansiedad , Prejuicio , Psicología , Autoimagen , Automutilación , Delgadez , Industria de la Belleza , Vómitos , Mujeres , Sistema Único de Salud , Pérdida de Peso , Salud Mental , Hambre , Muerte , Desnutrición , Diagnóstico , Dieta , Emociones , Alimentos , Insatisfacción Corporal , Distrés Psicológico , Distanciamiento Físico , Ortorexia Nerviosa , Soledad , ObesidadRESUMEN
Introducción. La prueba de provocación oral (PPO) para el diagnóstico de alergia a las proteínas de la leche de la vaca (APLV) presenta riesgos y requiere de recursos. Nuestro objetivo fue evaluar condiciones y pruebas complementarias para identificar una alta probabilidad de APLV. Población y métodos. Análisis secundario sobre estudio de pacientes atendidos en una unidad de alergia entre 2015 y 2018. Se determinaron las probabilidades prepruebas asociadas a los síntomas y sus combinaciones, y las probabilidades pospruebas luego de realizadas pruebas cutáneas y determinación de inmunoglobulina E (IgE) sérica. Resultados. Se evaluó la información de 239 pacientes. Se observaron probabilidades mayores al 95 % en pacientes con angioedema y combinación de urticaria y vómitos. Usando puntos de corte propuestos por Calvani et al., la combinación de vómitos con rinitis, sin angioedema, también superó el 95 %. Conclusión. Se ofrece una metodología para identificar pacientes en los que puede diagnosticarse APLV sin realización de PPO.
Introduction. The oral food challenge (OFC) for the diagnosis of cow's milk protein allergy (CMPA) poses risks and requires resources. Our objective was to assess conditions and complementary tests used to identify a high probability of CMPA. Population and methods. Secondary analysis of a study of patients seen at a unit of allergy between 2015 and 2018. Pre-testing probabilities associated with symptoms and their combinations and post-testing probabilities after skin prick testing and serum immunoglobulin E (IgE) levels were determined. Results. The data from 239 patients were assessed. A probability greater than 95% was observed for angioedema and a combination of urticaria and vomiting. Based on the cut-off points proposed by Calvani et al., the combination of vomiting with rhinitis, without angioedema, also exceeded 95%. Conclusion. A methodology is provided to identify patients in whom CMPA may be diagnosed without an OFC.
Asunto(s)
Humanos , Animales , Lactante , Hipersensibilidad a la Leche/diagnóstico , Hipersensibilidad a la Leche/epidemiología , Angioedema/complicaciones , Vómitos , Bovinos , Pruebas Cutáneas/métodos , Proteínas de la Leche/efectos adversosRESUMEN
OBJECTIVE: evaluate the efficacy of Zingiber Officinale in the management of nausea and vomiting induced by treatment with cisplatin associated with radiotherapy in patients with uterine cervical neoplasms. METHODS: a triple-blind, randomized, placebo-controlled trial. Interventions: Comparing the effects of ginger with institutional antiemetic therapy (ondansetron with dexamethasone). Patients with cervical cancer who started treatment with cisplatin with an indication of 40 mg/m² associated with radiotherapy, aged over 18 years, and with the ability to tolerate swallowing a capsule were recruited and equally allocated (1:1:1) into 3 groups of 16 patients each (the ginger capsules 250 mg group, ginger capsules 500 mg group, and placebo group). Nausea and vomiting were measured on baseline, 7 days after the first dose of medication and every seven consecutive days during a treatment break. RESULTS: The 250 mg ginger group had an 8.0% greater chance of experiencing nausea within 24 h after the chemotherapy infusion than the placebo group, although there is no statistical significance (P = .92986). The 500 mg ginger group showed a 63.9% reduction in nausea under the same conditions (P = .40460). No change was detected in the occurrence of nausea episodes during the 6 weeks (P = .8664) or between the groups (P = .2817). No change was detected in acute or late vomiting during the 6 weeks (P = .3510) or between the groups (P = .8500 and P = .5389, respectively). CONCLUSION: Ginger supplementation does not reduce the intensity of acute and late nausea and vomiting. REBEC (RBR-47yx6p9).
Asunto(s)
Neoplasias del Cuello Uterino , Zingiber officinale , Femenino , Humanos , Adulto , Persona de Mediana Edad , Cisplatino/efectos adversos , Método Doble Ciego , Vómitos/inducido químicamente , Vómitos/tratamiento farmacológico , Náusea/inducido químicamente , Náusea/tratamiento farmacológicoRESUMEN
OBJECTIVE: To evaluate the effectiveness of acupuncture and auriculotherapy protocol in relieving chemotherapy-induced nausea and vomiting in cancer patients compared to the antiemetic protocol. METHOD: Pilot study of a pragmatic two-arm clinical trial: an acupuncture group received systemic acupuncture, auriculotherapy, and antiemetic protocol; a control group used antiemetic protocol. The sample consisted of 42 patients with cancer of the gastrointestinal system or multiple myeloma. The outcome was assessed using the Chemotherapy-Induced Nausea and Vomiting Assessment Tool and the patient's diary. RESULTS: There was no statistically significant difference between groups according to the assessment of the patient's diary and the Assessment Tool of chemotherapy-induced nausea and vomiting. The patients were 60 years old on average and the groups were homogeneous, except for marital status. In the diary, there was no statistical difference between groups and sessions for days of nausea (p = 0.873) and vomiting episodes (p = 0.993). CONCLUSION: The protocol of acupuncture and auriculotherapy as a complementary treatment of chemotherapy-induced nausea and vomiting was ineffective, considering the limitations of the study.