RESUMO
La toxicidad por antimoniales tiene múltiples manifestaciones sistémicas, entre ellas, las alteraciones cardiovasculares son de las de mayor gravedad, que pueden, incluso, llevar a la muerte. Reportamos el caso de una paciente anciana que durante el tratamiento con antimoniales para una leishmaniasis cutánea presentó toxicidad cardiaca y hepática con alteraciones electrolíticas como factor perpetuador de su condición clínica y con posterior desarrollo de múltiples episodios de taquicardia ventricular monomórfica y polimórfica. Durante el tratamiento recibió descargas sincrónicas y asincrónicas del desfibrilador, sobreestimulación con marcapasos y reposición de electrolitos, no se logró resolver del cuadro y la paciente falleció. Este reporte sobre la toxicidad de los antimoniales es importante porque están en la primera línea en el manejo de la leishmaniasis, a pesar de sus efectos sobre múltiples sistemas, por tanto, es necesario que los trabajadores de la salud se familiaricen con los signos y síntomas tempranos de su toxicidad.
Toxicity by antimonials has multiple systemic manifestations, including cardiovascular alteration, which is one of the most serious, as it can even lead to death of the patient. This article reports the case of an elderly patient who, during treatment with antimonials for cutaneous leishmaniasis, presented cardiac and hepatic toxicity associated with electrolyte imbalance as a perpetuating factor of her clinical condition, with subsequent development of multiple episodes of mono and polymorphic ventricular tachycardia. The patient was treated with synchronous and asynchronous defibrillation, overstimulation with pacemaker, and electrolyte replacement; she did not recover and eventually died. This report on the toxicity of antimonials is important as they remain the first-line treatment for leishmaniasis despite their multiple side effects, which can compromise multiple systems. Thus, health care professionals must become familiar with the early signs and symptoms of toxicity.
Toxicity by antimonials has multiple systemic manifestations, including cardiovascular alteration, which is one of the most serious, as it can even lead to death of the patient. This article reports the case of an elderly patient who, during treatment with antimonials for cutaneous leishmaniasis, presented cardiac and hepatic toxicity associated with electrolyte imbalance as a perpetuating factor of her clinical condition, with subsequent development of multiple episodes of mono and polymorphic ventricular tachycardia. The patient was treated with synchronous and asynchronous defibrillation, overstimulation with pacemaker, and electrolyte replacement; she did not recover and eventually died. This report on the toxicity of antimonials is important as they remain the first-line treatment for leishmaniasis despite their multiple side effects, which can compromise multiple systems. Thus, health care professionals must become familiar with the early signs and symptoms of toxicity.
Assuntos
Humanos , Leishmania , Arritmias Cardíacas , Sinais e Sintomas , Leishmaniose Cutânea , Eletrólitos , ToxicidadeRESUMO
Existe poca literatura nacional sobre las percepciones que tienen las personas viviendo con VIH/SIDA (PVVS) acerca de los servicios de salud vigentes que reciben. Objetivos: Recoger las percepciones de las PVVS sobre los servicios de salud especializados y el tratamiento antirretroviral de gran actividad (TARGA). Materiales y métodos: Estudio transversal con aplicación de una encuesta ad hoc, previamente validada, en los usuarios PVVS de los principales hospitales que proveen TARGA en cinco ciudades del Perú. Se planificó un muestreo no probabilístico de 488 PVVS y los participantes fueron enrolados por conveniencia en forma sucesiva hasta alcanzar el tamaño muestral. Resultados: Desde enero a marzo de 2007 se encuestó 578 PVVS en siete hospitales de las cinco ciudades. El 27,5 y 7,5 por ciento de los encuestados pertenecieron al género femenino y transgénero respectivamente. El 27,2 por ciento refirió que recibió el diagnóstico durante el 2006. El 28,2 por ciento refiere que antes había sido atendido en otro establecimiento y los principales motivos para el cambio fueron por indicación médica (51,5 por ciento) y maltrato del personal de salud (8 por ciento). La mayoría (85,3 por ciento) recibe actualmente TARGA, de los que no reciben, aproximadamente un tercio, ya tiene indicaciones para el inicio del tratamiento. De los que no han recibido TARGA, 10 por ciento refiere que es por desabastecimiento de medicinas Conclusiones: La implementación del Programa TARGA en el Perú evoca nuevas necesidades de investigación sobre la calidad de atención, acceso a atención integral y la adherencia.
National literature on people living with HIV/AIDS (PLWHA) perceptions on existing health services they receive is scarce. Objectives: To gather the perceptions of PLWHA on specialized health care services and highly active antiretroviral therapy (HAART) Materials and methods: A cross-sectional study with application of an ad-hoc survey, previously validated, in PLWHA users of the main hospitals that provide HAART in five cities of Peru. A non-probabilistic sample of 488 PLWHA was planned and participants were enrolled for convenience in succession to reach the sample size. Results: From January to March 2007, 578 PLWHA from 7 hospitals in 5 cities were enrolled. 27,5 per cent and 7,5 per cent of the respondents were female and transgender respectively. 27.2 per cent commented that received the diagnosis in 2006. 28,2 per cent referred previous management in another health facility and the main reasons for the change were for medical referral (51,5 per cent) and abuse of health personnel (8 per cent). 85,3 per cent are currently receiving HAART and of those who did not receive about one-third had already received indication for initiation of therapy, 10 per cent referred having not received HAART by shortages of medicines. Conclusions: The implementation of the HAART program in Peru evokes new research needs on the quality of care, access to comprehensive care and adherence.
Assuntos
Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Acessibilidade aos Serviços de Saúde , Síndrome da Imunodeficiência Adquirida , Síndrome da Imunodeficiência Adquirida/terapia , Terapia Antirretroviral de Alta Atividade , Estudos Transversais , PeruRESUMO
Durante los meses de agosto 1997 a febrero 1998, se realizó un muestreo sistematizado a 410 gestantes que acudieron a su control al Instituto Materno Perinatal de Lima, con la finalidad de realizar un estudio de prevalencia de infección por Neisseria gonorrhoeae y Chlamdia trachomatis. Las muestras consistieron en hisopados de la región endocervical, que fueron procesados para la búsqueda del Neisseria honosshoeae, mediante cultivo en agar Thayer Martin modificado, y detección de Chlamydia trachomatis, mediante las técnicas de ELISA de captura de antígeno, inmunofluorescencia directa y cultivo celular. No se halló Neisseria gonorrhoeae en las gestantes estudiadas, pero se encontró. Chlamydia trachomatis en un 34,8, siendo más frecuente en las edades comprendidas entre 33-37 años. Además, se observó que 80,5 de las gestantes infectadas por Chlamydia no presentaron molestias en la región genital, lo que indica que la población infectada por dicha bacteria puede pasar inadvertida por mucho tiempo,antes de ser diagnosticada, que por lo regular ocurre cuando la infección alcanza cierta complicación o cuando el recien nacido tiene problemas a nivel de las vías respiratorias o presenta tracoma
Assuntos
Gravidez , Chlamydia trachomatis , Prevalência , Neisseria gonorrhoeaeRESUMO
Twelve pigs were randomly assigned to 1 of 2 groups, droperidol or midazolam, to determine a sedative dose of each drug that would facilitate handling of the pigs. Each pig in the group received all of the test doses with 5-7 d between treatments (droperidol--0.1, 0.3, 0.6 mg/kg, or midazolam--0.25, 0.5, 1.0 mg/kg) and saline (3 mL), i.m. One investigator, unaware of the treatment administered, assessed the time of onset, degree, and duration of sedation. The 0.3 mg/kg dose of droperidol and 0.5 mg/kg dose of midazolam were judged to be the most suitable for sedation and produced similar degrees of sedation, although the onset and duration of sedation was significantly longer for the droperidol group. The effects of these 2 doses on heart rate, respiratory rate, systolic blood pressure, and rectal temperature were assessed in 12 pigs randomly assigned to 1 of the 2 treatments. Respiratory rate decreased significantly with droperidol at 10, 15, and 30 min. Temperature was significantly decreased at 60 min following midazolam. This study demonstrates that 0.3 mg/kg i.m. of droperidol and 0.5 mg/kg i.m. of midazolam induce adequate sedation in pigs with minimal cardiorespiratory changes.
Assuntos
Ansiolíticos/farmacologia , Antipsicóticos/farmacologia , Sistema Cardiovascular/efeitos dos fármacos , Droperidol/farmacologia , Hipnóticos e Sedativos/farmacologia , Midazolam/farmacologia , Suínos/fisiologia , Animais , Ansiolíticos/administração & dosagem , Antipsicóticos/administração & dosagem , Relação Dose-Resposta a Droga , Droperidol/administração & dosagem , Feminino , Hipnóticos e Sedativos/administração & dosagem , Injeções Intramusculares/métodos , Injeções Intramusculares/veterinária , Masculino , Midazolam/administração & dosagem , Distribuição Aleatória , Respiração/efeitos dos fármacos , Respiração/fisiologia , Fatores de TempoRESUMO
Xenobiotic estrogens in the environment or diet have received much attention as a possible source of certain hormonal disease states in human and wildlife. Therefore, the detection of estrogenic activity of any substance, especially those related to the food industry, is important. The estrogenic activity of p-hydroxybenzoic acid (PHBA), a compound related to a commonly used group of preservatives in food, cosmetic, and pharmaceutical preparations, was evaluated with immature and adult ovariectomized female mice (CD1) using two well-known bioassays. Subcutaneous administrations (s.c.) of different doses of PHBA were compared with estradiol (E2), and their effects on vaginal cornification and uterotrophic activities were evaluated. Different groups of animals were treated s.c. daily for 3 days with vehicle (corn oil, 0.3 ml/100 g), E2 (1 microgram/100 g), and PHBA (0.5, 5, 50, and 500 micrograms/100 g). Four days after treatment, PHBA produced a dose-dependent response on vaginal cornification and uterotrophic activity in both immature and adult ovariectomized mice. The relative uterotrophic potency of PHBA (500 micrograms/100 g) to E2 (1 microgram/100 g) was 0.0011 in immature mice and 0.0018 in ovariectomized animals.
Assuntos
Estrogênios não Esteroides/toxicidade , Parabenos/toxicidade , Xenobióticos/toxicidade , Animais , Bioensaio , Relação Dose-Resposta a Droga , Poluentes Ambientais/administração & dosagem , Poluentes Ambientais/toxicidade , Estradiol/administração & dosagem , Estradiol/farmacologia , Estrogênios não Esteroides/administração & dosagem , Feminino , Conservantes de Alimentos/administração & dosagem , Conservantes de Alimentos/toxicidade , Humanos , Camundongos , Tamanho do Órgão/efeitos dos fármacos , Ovariectomia , Parabenos/administração & dosagem , Conservantes Farmacêuticos/administração & dosagem , Conservantes Farmacêuticos/toxicidade , Útero/efeitos dos fármacos , Útero/patologia , Vagina/efeitos dos fármacos , Vagina/patologia , Xenobióticos/administração & dosagemRESUMO
PURPOSE: To evaluate the clinical findings and complementary investigation to support the diagnosis of arrhythmogenic right ventricular dysplasia. METHODS: Six males with a mean age of 40 years old with episodes of sustained ventricular tachycardia with left bundle branch block pattern. All patients were submitted to a clinical investigation, EKG X rays and echocardiograms. In five patients an electrophysiologic study was performed. All patients were treated with anti-arrhythmic drugs. RESULTS: Palpitation was the most common complaint. T-wave inversion in leads V1-V3 was present in 4 patients. An epsilon wave was noted in 2 patients. The chest X ray was abnormal in only 1 patient. All patients had an abnormal echocardiogram, with consisted in the dilatation of the outflow tract of the RV and hypocontractility. In 2 patients aneurysm of the basal RV free wall below tricuspid valve were detected. Ventricular post-excitation waves were present in 4 patients. After a mean follow-up of 37 months, 5 patients were asymptomatic with anti-arrhythmic drugs and one in therapeutic adjustment. CONCLUSION: In patients with ventricular tachycardia with left bundle branch block pattern, the diagnosis of arrhythmogenic right ventricular dysplasia was substantiated by echocardiographic data and electrocardiographic findings such a T-wave inversion during sinus rhythm and ventricular post-excitation waves. The results obtained with anti-arrhythmic drugs in our study group, suggest that drug therapy should be the first and best approach to treat patients with this type of pathology.
Assuntos
Taquicardia/diagnóstico , Adulto , Idoso , Antiarrítmicos/administração & dosagem , Antiarrítmicos/uso terapêutico , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/fisiopatologia , Diagnóstico Diferencial , Ecocardiografia , Eletrocardiografia , Eletrofisiologia , Teste de Esforço , Seguimentos , Ventrículos do Coração/anormalidades , Humanos , Masculino , Pessoa de Meia-Idade , Exame Físico , Prognóstico , Taquicardia/tratamento farmacológico , Taquicardia/fisiopatologiaRESUMO
A 24-hour recording of ambulatory EKG (Holter) was obtained in 159 patients with coronary disease: previous myocardial infarction (n = 76), myocardial revascularization (n = 66), severe obstruction during cine-coronarography (n = 13) or during coronary angioplasty (n = 4). Prophylactic anti-anginal drugs were maintained during the Holter and, despite the medication, transitory episodes of myocardial ischemia (MI) were recorded in 51 patients (32%), either with angina (AMI) or silent (SMI), isolated SMI was recorded in 44 patients (86%), 6 subjects had both SMI (16 episodes) and AMI (12 episodes) and one patient had only one episode of AMI. There was a total of 119 episodes of MI, 106 of SMI (89.1%) and 13 AMI (10.9%). The total duration of the episodes of SMI per patient varied from 1 min to 235 min and the IMS maximal duration was 221 min. In the six cases with both SMI and AMI, the total duration of SMI was 461 min and AMI was 306 min. The circadian distribution of the episodes of SMI was: from 12:00 to 18:00-31.4%, 18:00 to 24:00-27.6%, 0:00 to 6:00-7.7% and 6:00 to 12:00-33.3%. The SMI activity was recorded in 89 episodes-23.6% during sleep, 22.4% at rest, 46% during physical activity and 8% during other activities. The mean ST segment depression during SMI (n = 106) was of -2.25 mm and during AMI (n = 13) was of -3.25 mm.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Doença das Coronárias/diagnóstico , Eletrocardiografia , Monitorização Fisiológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Antiarrítmicos/uso terapêutico , Doença Crônica , Doença das Coronárias/tratamento farmacológico , Doença das Coronárias/fisiopatologia , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , PrognósticoRESUMO
Se presenta un caso de fibromatosis gingival idiopatica con destruccion osea asociada a amelogenesis imperfecta, en un joven de trece anos, sin aparente enfermedad sistemica