RESUMO
Las situaciones de intimidación entre escolares emergen como un fenómenosocial complejo, culturalmente determinado, que ha ganado interés por supotencial impacto en la salud física, mental y social, particularmente en lainfancia. Un estudio previo en Bahía Blanca encontró que 36% de una muestrade escolares manifestaron participar en situaciones de intimidación.ObjetivosDescribir la magnitud de la intimidación entre pares, su relación con la Calidadde Vida Relacionada a la Salud (CVRS) y el clima escolar en cuatro escuelasmunicipales de Córdoba (CBA). Evaluar la factibilidad de implementar unaintervención en escuelas públicas de Bahía Blanca (BBCA).MétodosEn Córdoba se realizó un estudio cuantitativo y cualitativo (observación,entrevistas individuales y grupales). En Bahía Blanca se llevó a acabo un estudiode factibilidad y diseño antes-después. Se aplicaron cuestionarios a niños,padres y docentes sobre intimidación (PRECONCIMEI) y CVRS (KIDSCREEN).ResultadosCBA: De 560 alumnos, 39% refirió participar en situaciones de intimidación:17%agresores, 12% víctimas y 10% víctima-agresor. Estos últimos dos grupos presentaronmenores puntuaciones en CVRS. De 345 padres encuestados, 49% afirma que en laescuela que concurre su hijo/a ocurren situaciones de intimidación. En las escuelascon un clima escolar más desfavorable, se observó mayor frecuencia de niños/as conrol agresor y una percepción más negativa de las docentes. BBCA: se implementóuna intervención preventiva, universal, para fortalecer el clima escolar, con 8componentes centrales sustentados en un marco teórico y 14 periféricos.ConclusionesSi bien la frecuencia de intimidación y niveles de CVRS de los niños/as evidenciaron unempeoramiento al finalizar el año, los docentes y directivos valoraron positivamentelos contenidos, estrategias y la adaptabilidad de la intervención. Manifestaron estardispuestos a implementarla en su práctica el próximo año.
Assuntos
Bullying , Bolsas de Estudo , Qualidade de Vida , Estudos de ViabilidadeRESUMO
OBJETIVO: Describir los efectos de la restricción moderada del sueño en las regiones cerebrales involucradas en los procesos de inhibición cognitiva, función motora y fluidez fonológica, utilizando imágenes por resonancia magnética funcional (RMf). Materiales y métodos: Se estableció una condición de sueño habitual y otra de restricción moderada en 12 estudiantes diestros de pre y posgrado de Medicina, de entre 20 y 40 años. En ambos estados se utilizó la prueba psicológica de atención d2 e imágenes de RMf con paradigmas de función motora, fluencia fonológica y atención del tipo inhibición de la función ejecutiva Stroop. La restricción moderada de sueño fue de al menos el 63% con respecto al sueño habitual. Resultados: Se encontraron diferencias significativas en la activación cerebral con RMf para la función motora (p<0,05) entre el ciclo de sueño regular y el de restricción moderada. La actividad cerebral en RMf con los paradigmas de atención Stroop y fluidez fonológica no mostró diferencias significativas, así como tampoco la prueba psicológica de atención d2. Discusión: Se encontró interferencia en las activaciones cerebrales de representación motora con la restricción moderada de sueño, pero no se hallaron diferencias significativas en las activaciones de atención tipo Stroop, ni en la tarea de fluencia fonológica o las pruebas de atención d2. Esto podría deberse a una insuficiente restricción del sueño o a eficientes mecanismos de compensación en los sujetos de este estudio. Conclusión: Existen diferencias en las activaciones cerebrales de representación motora en la restricción moderada del sueño medidas con RMf
OBJECTIVE: To describe the effects of moderate sleep deprivation in brain regions involved in cognitive inhibition processes, motor function, and phonological fluency using functional Magnetic Resonance Imaging (fMRI). Materials and methods: A sample of 12 under-graduate and post-graduate medical students, between 20 and 40 years, were subjected to a follow-up of the number of hours of regular sleep in order compare to a moderate sleep deprivation after a nightshift. The d2 attention test and fMRI studies were used in both groups in order to evaluate motor function, verbal fluency and cognitive inhibition, or Stroop paradigms. The moderate sleep deprivation was at least 63% with respect to the regular sleep pattern during the previous week. Results: Significant differences in brain activity were found in fMRI to measure motor function (P<0.05) comparing regular sleep cycle and moderate sleep deprivation. The brain activity with fMRI Stroop paradigms and phonological fluency showed no significant differences between the two conditions, likewise with the psychological attention test d2. Discussion: The fMRI showed interference on motor representation activations in moderate sleep deprivation. No significant differences in fMRI were found in the processes of cognitive inhibition or Stroop paradigms, in phonological fluency, or in the psychological attention test d2. These could be attributed to inadequate sleep deprivation or efficient compensation mechanisms in the subjects of this study. Conclusión: There is a difference showed in fMRI on motor representation activations in moderate sleep deprivation
Assuntos
Humanos , Masculino , Feminino , Adulto , Transtornos do Sono do Ritmo Circadiano , Sono , Privação do Sono , Imageamento por Ressonância Magnética , PolissonografiaRESUMO
OBJECTIVES: To determine the lymphoproliferative response to the 30-kDa protein (p30) of Salmonella typhimurium in patients with ankylosing spondylitis (AS). METHOD: Lymphoproliferative response was determined in peripheral blood mononuclear cells (PBMCs) from 30 patients with AS and 40 healthy subjects. Cells were cultured with concanavalin A (Con A), a crude lysate of S. typhimurium (StCL), or p30. Lymphoproliferation was measured by the MTT assay. RESULTS: Our data show that the mitogenic response to Con A was similar in both groups studied; however, the lymphoproliferative response to StCL and p30 was statistically higher in AS patients than in healthy subjects. CONCLUSIONS: Our data strongly suggest that S. typhimurium, and particularly p30, are associated with AS.
Assuntos
Proteínas de Bactérias/imunologia , Infecções por Salmonella/complicações , Salmonella typhimurium/imunologia , Espondilite Anquilosante/imunologia , Espondilite Anquilosante/microbiologia , Adulto , Concanavalina A/imunologia , Feminino , Humanos , Imunidade Celular , Linfócitos/fisiologia , Masculino , Pessoa de Meia-IdadeRESUMO
La premedicación anestésica con midazolam, permite disminuir la ansiedad de los niños y los padres así como los requerimientos analgésicos, la aparición de eventos psicológicos negativos en el postoperatorio, y acorta los tiempos de inducción inhalatoria de la intubación orotraqueal. Se han desarrollado preparaciones magistrales utilizando ampollas de administración parenteral mezcladas con sustancias que modifican su sabor para mejorar la aceptación. Para determinar la eficacia de la premedicación con midazolam mezclado con acetaminofén se realizó un estudio observacional descriptivo prospectivo en 216 niños ASAI o II sometidos a procedimientos quirúrgicos o diagnósticos que requerían anestesia general; se aplicaron escalas de ansiedad-sedación (Yale modificada y RASS) y se valoró la tolerancia a la separación de los padres. Resultados: La escala de RASS aplicada al momento de la inducción evidenció que el 92% de los pacientes se encontraban en un grado adecuado de sedación para tolerar la máscara facial y la inducción inhalatoria, y además el 86% de los pacientes toleró de manera adecuada la separación de sus padres. El 61,6% de los pacientes se encontraban con un grado adecuado de sedación ansiólisis con la escala de Yale, previo al momento de la separación de los padres. Edad, género, escolaridad, estrato socioeconómico, tipo de valoración preanestésica o antecedente de anestesia no se correlacionaron con el grado de ansiedad-sedación. Conclusiones: La premedicación con la mezcla magistral utilizada disminuye la ansiedad en el momento en que el niño se separa de sus padres y permite una buena aceptación de la inducción anestésica inhalada.
Anesthetic premedication with midazolam helps reduce anxiety in the children and the parents, the need for analgesic use, and the development of negative psychological events during the postoperative period; it also results in shorter inhalation induction and orotracheal intubation. Compounded preparations have been developed using ampoules for parenteral administration mixed with flavor modifiers in order to improve acceptance. To determine the efficacy of premedication using a mix of midazolam plus acetaminophen, a prospective descriptive observational study was conducted in 216 children ASAI or II, scheduled for surgical or diagnostic procedures requiring general anesthesia. Anxiety-sedation scales were given (Modified Yale scale and RASS), and tolerance to separation from the parents was assessed. Results: The RASS scale applied at the time of induction showed that 92% of the patients were at an appropriate level of sedation to tolerate facemask inhalation induction, and 86% of patients tolerated well their separation from their parents. It was found that age, gender, education, socioeconomic status, pre-anesthetic check type (telephonic or in person), or a history of previous anesthesia, did not have a statistically significant correlation with the degree of anxiety-sedation. Conclusions: Premedication with a compounded preparation does reduce anxiety at the time of separating the child from its parents, and allows a good acceptance of the inhaled anesthetic induction.
Assuntos
HumanosRESUMO
Piglets appear to be neurologically sensitive to intrapartum asphyxia. Our aim was to investigate the short-term neurophysiologic consequences of intrapartum asphyxia in piglets. We studied 10 piglets suffering intrapartum asphyxia and 10 control piglets. Glucose and blood gas levels, tympanic membrane temperature, and body weight were measured within the first 2 min after birth. Animals were followed up for a 5-day period. As surrogated markers of piglets' neurological function, a viability score and the time elapsed from birth to the first contact with the maternal udder were recorded. In the control group, temperature and blood pH levels at birth were significantly higher (p < or = .001), whereas calcium, lactate and PCO2 levels were statistically lower (p < or = .05) than in the piglets experiencing intrapartum asphyxia. Lower temperature and blood pH levels as well as higher blood PCO2 and lactate levels were observed in piglets with lower viability scores and in piglets with prolonged times until first udder contact. At the end of the study, asphyxiated piglets weighed on average 200 g less (p = .023) than control piglets. In conclusion, intrapartum asphyxia in spontaneously born piglets was associated with signs of acute neurological dysfunction and lower weight gain, supporting the hypothesis that they may be used as a naturalistic model for the study of asphyxia in newborns.
Assuntos
Asfixia/fisiopatologia , Parto/fisiologia , Acidose Respiratória/diagnóstico , Acidose Respiratória/metabolismo , Acidose Respiratória/fisiopatologia , Animais , Animais Recém-Nascidos , Asfixia/diagnóstico , Asfixia/metabolismo , Gasometria/métodos , Glicemia/metabolismo , Glicemia/fisiologia , Eletrólitos/metabolismo , Feminino , Parto/metabolismo , Distribuição Aleatória , Suínos , Fatores de TempoRESUMO
We describe a 20-month-old girl with hypereosinophilia, hyper-immunoglobulin (Ig) E syndrome, and atopic dermatitis. Her peripheral eosinophil count and IgE plasma levels were 2.65 x 10(9)/L and 6702 IU/mL, respectively. Specific IgE levels for a variety of foods and inhalants were high and single-blind food challenges were positive for cow's milk, hen's egg, oat, wheat, and soy. When the patient received an extensively hydrolyzed milk formula, an exclusion diet, and 2 mg/kg of prednisone daily, the atopic dermatitis partially improved. Further improvement was observed with 1 mg/kg of azathioprine daily. Long-term clinical response was satisfactory. We suggest that food hypersensitivity should be ruled out in patients with hypereosinophilia, hyper-IgE syndrome, and atopic dermatitis. Azathioprine may be a good therapeutic alternative for treatment in such cases.
Assuntos
Dermatite Atópica/complicações , Hipersensibilidade Alimentar/complicações , Síndrome Hipereosinofílica/complicações , Síndrome de Job/complicações , Azatioprina/uso terapêutico , Exame de Medula Óssea , Separação Celular , Terapia Combinada , Dermatite Atópica/dietoterapia , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/imunologia , Diagnóstico Diferencial , Feminino , Citometria de Fluxo , Hipersensibilidade Alimentar/dietoterapia , Hipersensibilidade Alimentar/imunologia , Humanos , Síndrome Hipereosinofílica/imunologia , Imunoglobulinas/sangue , Lactente , Síndrome de Job/imunologia , Prednisona/uso terapêuticoRESUMO
AIM: To review the basic molecular mechanisms that are triggered by neuroactive steroids related to protection and plasticity, and their possible therapeutic application in cases of cerebral ischaemia. DEVELOPMENT: The term 'neuroprotection' embraces a series of strategies and effects that are aimed at preventing, impeding or delaying anomalies in the functioning of the central nervous system. The neuroactive steroids, and particularly estradiol, have been widely reported owing to their neuroprotective action because they give rise to a wide range of cell signals and generate effects in genes by means of canonical pathways or through non-conventional mechanisms that are involved in neuronal survival, dendritogenesis and synapse remodelling. Thus, neuroactive steroids become an important long-term protective therapeutic alternative due to the fact that such effects converge on neuronal plasticity. CONCLUSIONS: Further work needs to be carried out to study the mechanisms of action of neuroactive steroids, especially the non-conventional ones, which involve proteins such as GSK-3beta and beta-catenin. These proteins are involved in the functions of synaptic plasticity and survival, and play a crucial role in maintaining and recovering the functional integrity of the brain after the appearance of the lesions caused by cerebral ischaemia.
Assuntos
Encefalopatias/prevenção & controle , Isquemia Encefálica/complicações , Estradiol/uso terapêutico , Plasticidade Neuronal/efeitos dos fármacos , Fármacos Neuroprotetores/uso terapêutico , Proteínas Repressoras/fisiologia , Sinapses/efeitos dos fármacos , Animais , Isquemia Encefálica/fisiopatologia , Humanos , Plasticidade Neuronal/fisiologia , Sinapses/fisiologiaRESUMO
En este estudio se realizó una evaluación de la estabilidad clínica de los miniimplantes utilizados como anclaje óseo para la intrusión de molares superiores. Se emplearon treinta y cuatro mini implantes de acero inoxidable marca Leone® de cuatro dimensiones (1,5 x 10 mm, 1,5x12 mm, 2 x 10 mm y 2 x 12 mm), en nueve pacientes y un total de dieciocho dientes por intruir. El procedimiento de inserción se hizo de acuerdo con las recomendaciones del fabricante. La estabilidad de los mini implantes se evaluó mensualmente midiendo su movilidad clínica por medio de un calibrador digital. Se encontró que todos los miniimplantes colocados fueron efectivos como anclaje óseo para realizar el movimiento intrusivo a pesar de la aparición de movilidad en algunos de ellos, lo que indica que los mini implantes pueden tener cierto rango de movimiento sin perder su eficacia clínica. Se encontró que variables como la fuerza aplicada al miniimplante, la dimensión (longitud y diámetro) y el torque de inserción no tienen relación con la estabilidad. A diferencia de esto se halló que los mini implantes ubicados en la mucosa palatina fueron más estables que los localizados en la zona vestibular. La encía queratinizada presenta mejores condiciones clínicas (menor inflamación e hiperplasia) que la mucosa alveolar para la colocación de los mini implantes que favorecen la estabilidad a través del tiempo. En ningún molar se encontraron signos de reabsorción radicular en la evaluación radiográfica.
Assuntos
Implantes Dentários , Ortodontia , Técnicas de Movimentação DentáriaRESUMO
BACKGROUND: The aim of this study was to investigate the relationship between food hypersensitivity and atopic dermatitis (AD) in young children. MATERIAL AND METHODS: In a case-control design, 28 patients < 3 years old, with AD and 28 age-matched healthy children were included in the study. A detailed medical history of allergies and timing of weaning was obtained. Children underwent skin tests (prick and patch) to evaluate food hypersensitivity. The status of DA and food allergies in the study participants was investigated 4 years later. RESULTS: There were more children with positive skin tests for food hypersensitivity among cases than controls, OR 4.2 (95%CI 1.3 to 13.4). In contrast, there were no differences in the number of children with positive family history of allergic diseases or weaned at < or = 6 months of age between groups. Four years later, out of the 28 original cases, the state of AD was investigated in 13 (46.4%) infants. Of them, 11 followed an exclusion diet; 6 (46.1%) remained with AD. Of 28 original controls, 15 (51.7%) infants were investigated 4 years later; only one case developed AD. CONCLUSIONS: Young children who had hypersensitivity to cow's milk, hen egg, wheat, fish, soy, or legumes were found to have a higher risk of AD. Positive family history of allergies and early weaning were not found to be relevant risk factors.
Assuntos
Dermatite Atópica/epidemiologia , Hipersensibilidade Alimentar/epidemiologia , Desmame , Estudos de Casos e Controles , Pré-Escolar , Dermatite Atópica/genética , Feminino , Seguimentos , Hipersensibilidade Alimentar/etiologia , Humanos , Lactente , Masculino , México/epidemiologia , Valor Preditivo dos Testes , Testes CutâneosRESUMO
El control del anclaje es uno de los factores más importantes para el éxito del tratamiento ortodóncico. Para este fin se han utilizado diferentes mecanismos que van desde el uso de las estructuras dentarias hasta diferentes aditamentos intraorales y extraorales. Ninguno de estos métodos ha proporcionado anclaje óptimo. En un intento por superar dichas limitaciones y conseguir un anclaje absoluto se ha incursionado en el uso de implantes. Entre los implantes se encuentran los oseointegrados, los onplants, las miniplacas de titanio y los minitornillos. Hace dos décadas se empezaron a usar los miniimplantes, tiempo desde el cual su utilización ha incrementado notoriamente debido a sus múltiples ventajas, como tamaño reducido, baja costo, facilidad de inserción y remoción, técnica quirúrgica menos invasiva, posibilidad de carga inmediata, disminución del tiempo clínico y versatilidad clínica. Este artículo tiene como propósito integrar un conocimiento general sobre el uso de los miniimplantes como anclaje ortodóncico en diferentes aplicaciones clínicas haciendo referencia a sus orígenes, características, indicaciones, contraindicaciones, sitios seguros para su inserción y algunos ejemplos clínicos.
Assuntos
Implantes Dentários , Ortodontia , Osseointegração , TitânioRESUMO
BACKGROUND: There is some evidence suggesting a link between paracetamol exposure and atopy in both adults and children. OBJECTIVE: We aimed to investigate whether further epidemiological support for a link between paracetamol intake and allergy could be found in a population of Mexican children. METHODS: In a cross-sectional study design, we applied the ISAAC questionnaire to 3493 children aged 6 to 7 years old. Two analyses were performed: (1) children were classified as cases if they had wheezing, rhinitis, or eczema at any time from their neonatal period up until they reached the age of 6 to 7 years, or as controls if they had never experienced these conditions, and (2) children were classified as cases if they had wheezing, rhinitis, or eczema in the 12 months prior to the study. Paracetamol intake was considered positive if it frequently occurred during the first year of life (first analysis) or in the last 12 months (second analysis). RESULTS: Paracetamol intake in the first year of life was significantly associated with an increased risk of ev having wheezing (adjusted odds ratio [OR], 1.69; 95% confidence interval [CI], 1.23 to 2.34) and rhinitis (adjusted OR, 1.37; 95% CI, 1.20 to 1.59) but not eczema (adjusted OR, 1.45; 95% CI, 0.91 to 2.32). Frequent paracetamol intake in the last year increased the risk of wheezing (OR, 3.3; 95% CI, 1.54 to 7.18), rhinitis (OR, 1.61; 95% CI, 1.33 to 1.95), or eczema (OR, 1.82; 95% CI, 1.24 to 2.66). CONCLUSION: Frequent paracetamol exposure was associated with a significantly increased risk of wheezing and rhinitis and probably eczema in a Mexican population of children.
Assuntos
Acetaminofen/efeitos adversos , Dermatite Atópica/induzido quimicamente , Sons Respiratórios/etiologia , Rinite/induzido quimicamente , Acetaminofen/administração & dosagem , Analgésicos não Narcóticos/administração & dosagem , Analgésicos não Narcóticos/efeitos adversos , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Estudos de Casos e Controles , Criança , Pré-Escolar , Dermatite Atópica/etiologia , Dermatite Atópica/metabolismo , Feminino , Humanos , Hipersensibilidade Imediata/induzido quimicamente , Hipersensibilidade Imediata/etiologia , Hipersensibilidade Imediata/metabolismo , Lactente , Recém-Nascido , Masculino , México , Estresse Oxidativo/efeitos dos fármacos , Rinite/etiologia , Rinite/metabolismo , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: This study aimed to evaluate the adverse effects of extensively hydrolyzed milk formula on growth in infants and toddlers. METHODS: Prospectively, 45 infants and toddlers with a positive history of cow's milk allergy confirmed by positive skin prick test and high IgE levels for either alpha-lactalbumin, beta-lactoglobulin, or casein and positive single-blind food challenge received extensively hydrolyzed milk formulas for 1 year. Sex-normalized percentiles of heights and weights of infants and toddlers before their enrollment in the study were compared to those at the end of the study. The contribution of breastfeeding, early use of bottle feeding and intake of adapted or special milk formulas, and history of bronchitis and atopic dermatitis on toddlers' growth were also evaluated by multivariate analysis. RESULTS: Similar percentiles of the children's weight and height were observed at the beginning of the study and 1 year later. According to the multivariate analysis, sex, breastfeeding, early bottle feeding, ingestion of adapted or special milk formulas, atopic dermatitis, and bronchitis were not correlated with either the children's weight or height at diagnosis of the allergy or at 1 year of follow-up (P > .10). Weights and heights were not different between toddlers who had atopic dermatitis or bronchitis during the study period and those who did not. CONCLUSIONS: Growth of infants and toddlers with cow's milk allergy was not affected by the intake of extensively hydrolyzed milk for 1 year. Atopic dermatitis and bronchitis did not appear to have any deleterious effect on these children's growth.
Assuntos
Bronquite/imunologia , Dermatite/imunologia , Fórmulas Infantis/química , Leite/imunologia , Animais , Estatura , Aleitamento Materno , Bronquite/sangue , Caseínas/metabolismo , Dermatite/sangue , Feminino , Seguimentos , Humanos , Imunidade Inata/imunologia , Imunoglobulina E/sangue , Imunoglobulina E/imunologia , Lactente , Lactoglobulinas/sangue , Lactoglobulinas/imunologia , Masculino , Leite/efeitos adversos , Estudos Prospectivos , Método Simples-CegoRESUMO
Las displasias verticales son entidades complejas de origen multifactorial, donde tanto factores genéticos como ambientales están involucrados. Ellas pueden afectar las estructuras dentoalveolares, las esqueléticas o ambas. Una identificación precisa de sus características es fundamental para lograr el diagnóstico acertado que permita establecer el plan de tratamiento adecuado. Este artículo tiene como propósito integrar un conocimiento general de las alteraciones en el plano vertical enfocado hacia el diagnóstico, evaluando los diferentes factores etiológicos y las características faciales, cefalométricas, oclusales y articulares de las displasias verticales esqueléticas (el síndrome de cara corta y el síndrome de cara larga) y de las alteraciones verticales dentoalveolares.
Assuntos
Face , Respiração Bucal , Mordida Aberta , OrtodontiaRESUMO
AIM: Rocuronium may be a good alternative to pancuronium in cardiac surgical patients. We evaluate the hemodynamic response to rocuronium and pancuronium administered to cardiac surgical patients. METHODS: A single-blind, randomized clinical trial was carried out at the National Institute of Cardiology in Mexico. Twenty-two patients older than 18 years, NYHA class III-IV, and scheduled to undergo an elective cardiovascular surgical procedure were enrolled. Patients were randomly allocated to receive an i.v. bolus dose of either pancuronium 100 microg/kg or rocuronium 600 microg/kg. Peripheral arterial (radial) and venous cannulations and insertion of a multi-lumen pulmonary artery flotation catheter through the right internal jugular vein were carried out under local anesthesia. Anesthetic induction with an i.v. bolus dose of fentanyl 700 microg and diazepam 20 mg was performed and thereafter the neuromuscular blocking agent was administered. Ventilation with O2 100% was performed until a TOF < or =5% was observed and tracheal intubation was performed. After intubation, patients were maintained with O2 10 mL/kg administered by means of a pulmonary ventilator at a pressure of 20-25 cm H2O. The basal, pre-laryngoscopy, post-intubation, and pre-operative recording of a set of cardiovascular parameters were obtained. RESULTS: No differences (P>0.05) in the hemodynamic response were observed between pancuronium and rocuronium nor during the different evaluation times in each group. CONCLUSIONS: Rocuronium can be a safe alternative to pancuronium for patients requiring cardiac surgical procedures.
Assuntos
Androstanóis , Procedimentos Cirúrgicos Cardíacos , Hemodinâmica/efeitos dos fármacos , Fármacos Neuromusculares não Despolarizantes , Pancurônio , Adulto , Androstanóis/economia , Anestesia Geral , Procedimentos Cirúrgicos Cardíacos/economia , Feminino , Humanos , Masculino , Fármacos Neuromusculares não Despolarizantes/economia , Pancurônio/economia , Rocurônio , Método Simples-CegoRESUMO
BACKGROUND: Several neuromuscular blocking (NMB) agents are available for clinical use in anesthesia. The present study was performed in order to identify preferences and behaviors of anesthesiologists for using vecuronium, rocuronium or other NMB agents in their clinical practice. MATERIAL AND METHODS: The cross-sectional survey was applied at the Updated Course of the Colegio Mexicano de Anestesiología performed last year. Of 989, 282 (28.5%) surveys were returned. RESULTS: Most anesthesiologists were working at both public and private hospitals, performed anesthetic procedures for hospitalized and ambulatory patients, and anesthetized children as well as adults. Respondents did not consider mechanomyography as the gold standard method for neuromuscular monitoring. The T25 was not recognized as a pharmacodynamic parameter that represents the clinical duration of the neuromuscular block. Most answered that vecuronium induces less histamine release than rocuronium, had never used any neuromuscular monitor, did not know the cost of vecuronium and rocuronium, and preferred rocuronium in multiple-sampling vials and vecuronium in either a vial for single or multiple sampling. Rocuronium was preferred for emergency surgery in patients with full stomach only. Almost all of anesthesiologists that conserve the unused drug did it without refrigeration and more than 30% conserve the unused drug in one syringe for further use. CONCLUSION: Vecuronium was preferred for most clinical situations, and the decision for this choice was not based on costs. Storage of unused drugs without refrigeration in a single syringe for purpose of future use in several patients represented a dangerous common practice.
RESUMO
BACKGROUND: Uveitis is considered an autoimmune disease that compromises any internal structure of eye; its main characteristic is the inflammatory process inside eye. OBJECTIVE: To determine which is the most effective therapy for autoimmune uveitis: cyclophosphamide, azathioprine and prednisone. MATERIAL AND METHODS: Patients between 16 and 65 years old, both sexes, with diagnosis of autoimmune uveitis (anterior, intermediate and posterior). Patients were submitted to clinical history, physical exploration and clinical studies. Their written informed consent was requested and patients were divided into three treatment groups: group 1 (azathioprine) 14 (42.4%) patients; group 2 (prednisone) 15 (45.5%) patients, and group 3 (cyclophosphamide) 4 (12.1%) patients. Blind double observations and assessments at day 0 and at week 1, 2, 4 and 6 of treatment were performed. RESULTS: Out of 33 patients studied, 13 (39.4%) were male and 20 (60.6%) female, the most frequent diagnosis was uveitis due to Toxoplasmosis. With azathioprine 100 mg/day it was observed a better and faster control of inflammation after 6.2 weeks at anterior chamber with p < 0.0001, with prednisone, p = .000, and with cyclophosphamide, p = 135. In the posterior chamber there were no significant inflammatory changes for three groups with p = .353. The most frequent adverse effects occurred in the prednisone group with p < 0.05 in 24.2%, characterized by neutropenia and urinary tract infection. CONCLUSIONS: Azathioprine, 100 mg/day oral during six weeks, is considered the most effective drug, since it demonstrated significant diminishment of inflammatory process in less time, with less side effects and with conservation of visual acuity.
Assuntos
Anti-Inflamatórios/uso terapêutico , Doenças Autoimunes/tratamento farmacológico , Azatioprina/uso terapêutico , Ciclofosfamida/uso terapêutico , Imunossupressores/uso terapêutico , Prednisona/uso terapêutico , Uveíte/tratamento farmacológico , Adolescente , Adulto , Idoso , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: The aim of this study was to evaluate the benefits of an oral isosmolar solution of electrolytes (ISE) administered to interrupt a prolonged fasting period in children undergoing an elective surgical procedure under general anesthesia. METHODS: Forty unpremedicated children aged 3 to 12 years, ASA I, undergoing a surgical procedure requiring general anesthesia were assigned randomly to 1 of 2 groups. Group 1 consisted of patients with an overnight fasting period for milk and solids of at least 8 hours. In group 2, patients under a similar fasting period received a volume of 4 mL/kg of an oral ISE 3 hours before completing the fasting period. After anesthetic induction, blood glucose level (BGL) was quantified, and patients underwent an endoscopic examination to obtain the gastric content to determine the residual gastric volume (RGV) and pH levels. RESULTS: In group 1, the RGV was 0.78 +/- 0.44 mL/kg, pH was 1.75 +/- 0.38, and BGL was 86.4 +/- 14.5. In group 2, the RGV was 0.40 +/- 0.29 mL/kg, pH was 3.18 +/- 0.61, and BGL was 85.1 +/- 12.6. Only RGV and pH were significantly different between groups. CONCLUSION: A prolonged fasting period interrupted with oral ISE administration resulted in an RGV of low risk, without counterbalancing a potential fasting-induced hypoglycemia.
Assuntos
Procedimentos Cirúrgicos Eletivos , Eletrólitos/administração & dosagem , Jejum , Hidratação/métodos , Cuidados Pré-Operatórios , Glicemia , Criança , Pré-Escolar , Feminino , Ácido Gástrico/metabolismo , Esvaziamento Gástrico , Gastroscopia , Humanos , MasculinoRESUMO
Oxidative stress has been involved in the pathogenic process of a variety of diseases including diabetes mellitus. The production of oxidative reactive products has been involved in biochemical changes in bio-molecules that might produce tissue damage directly related to some of the main vascular complications in the diabetic patient. On the other hand, exercise, paradoxically, is a well-recognized model of oxidative stress and also an important therapeutic tool in diabetes management. Therefore, the relationship between oxidative stress and exercise in diabetic patients implies an interesting biochemical paradox due to some of the negative effects of exercise principally by the increase of oxidative species in plasma. The effect of oxidative stress during an acute exercise and after an aerobic training period on those patients remains unknown and needs to be studied.
Assuntos
Diabetes Mellitus/fisiopatologia , Exercício Físico/fisiologia , Estresse Oxidativo , Diabetes Mellitus/sangue , Humanos , Modelos Biológicos , Esforço Físico , Espécies Reativas de Oxigênio/fisiologiaRESUMO
Organophosphorus pesticides are the most common classes involved in poisonings related to pesticides. We used enzymatic activity of chloroperoxidase on the metabolism of some phosphorothioate pesticides published previously and molecular mechanics methods to perform a theoretical approach of the mechanism of biological oxidation of this class of pesticides. The molecular structure of eight pesticides were optimized by molecular mechanics methods using the CAChe program package for biomolecules, ver. 3.11 (Oxford Molecular Ltd., Campbell, CA). Total energy resulted from the structure optimization process and the partial charges of both phosphorus and sulfur were computed for every pesticide. Phosphorus partial charge and enzymatic activity were significantly related by linear regression analysis (r=0.82, P<0.05). Analyzing our results and using previously reported enzymatic activity of chloroperoxidase on these pesticides, we deduced chemical events involved in activation of the active site of chloroperoxidase and proposed a novel mechanism of oxidation for this class of pesticides. This mechanism will also help to understand the oxidation process of pesticides by cytochrome P450, and production of toxic metabolites.
Assuntos
Inseticidas/metabolismo , Compostos Organofosforados , Fenômenos Químicos , Físico-Química , Cloreto Peroxidase/metabolismo , Inseticidas/química , Oxirredução , Relação Estrutura-Atividade , Especificidade por SubstratoRESUMO
Oxidative stress has been defined as a loss of counterbalance between free radical or reactive oxygen species production and the antioxidant systems, with negative effects on carbohydrates, lipids, and proteins. It is also involved in the progression of different chronic diseases and apoptosis. Diabetes mellitus is associated to a high oxidative stress level through different biochemical pathways, i.e. protein glycosylation, glucose auto-oxidation, and the polyol pathway, mainly induced by hyperglycemia. Oxidative stress could also be involved in the pathogenesis of atherosclerotic lesions and other chronic diabetic complications. Measurement of oxidative stress could be useful to investigate its role in the initiation and development processes of chronic diabetic complications and also to evaluate preventive actions, including antioxidative therapy. Different attempts have been made to obtain a practical, accurate, specific, and sensitive method to evaluate oxidative stress in clinical practice. However, this ideal method is not currently available to date and the usefulness of the current methods needs to be confirmed in daily practice. We suggest quantifying oxidated and reduced glutation (GSSG/GSH) and the thiobarbituric reactive substances (TBARS) with currently alternatives. Currently available alternative methods while we await better options.