ABSTRACT
Rotigotina e outros medicamentos antiparkinsonianos, com ênfase em agonistas dopaminérgicos (bromocriptina e pramipexol). Indicação: Tratamento da doença de Parkinson. Pergunta: Há superioridade de eficácia e segurança da rotigotina, comparado aos agonistas dopaminérgicos disponíveis atualmente no SUS para o tratamento da doença de Parkinson? Revisão rápida de evidências (overview) de revisões sistemáticas, com levantamento bibliográfico realizado na base de dados PubMed e utilizando estratégia estruturada de busca. A qualidade metodológica das revisões sistemáticas foi avaliada com AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews Version 2). Foram selecionadas três revisões sistemáticas que atendiam aos critérios de inclusão. A rotigotina não apresenta eficácia e segurança superiores ao pramipexol; não há quantidade de estudos suficientes para comparação com a bromocriptina
Rotigotine and other antiparkinsonians medicines, with emphasis on dopaminergic agonists (bromocriptine and pramipexole). Indication: Treatment of Parkinson disease. Question: Is rotigotine more effective and safer than other dopamine agonists available in the Brazilian Public Health System for the treatment of Parkinson's Disease? Rapid evidence review (overview) from systematic reviews, with a literature search in the PubMed database by employing a structured strategy. The methodological quality of systematic reviews was evaluated using AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews Version 2). Three systematic reviews that met the inclusion criteria were selected. Rotigotine has not shown superior efficacy and safety when compared to pramipexole; there are insufficient studies for comparison with bromocriptine
Subject(s)
Parkinson Disease/drug therapy , Bromocriptine/therapeutic use , Dopamine Agonists , Pramipexole/therapeutic use , Antiparkinson Agents/therapeutic useABSTRACT
Pediatric patients have particularities in the clinical manifestations and complications of snakebite envenomation (SBEs), and few studies have examined this population. The objective of this paper was to study snakebites in a pediatric age group treated at a reference hospital and to evaluate factors associated with unfavorable evolution. A cross-sectional study with a clinical-epidemiological description and identification of the factors related to unfavorable evolution in patients aged <19 years old seen from January, 2018 to November, 2019 was performed. Complications related to the SBE, such as compartment syndrome, secondary infection, extensive necrosis, hemorrhage, and kidney damage, were considered unfavorable evolution. From the 325 patients in the sample, 58 were aged <19 years old; 40 (69%), 0-12 years old; and 18 (31%), 13-18 years old. All patients had local manifestations (mild, moderate, and severe), and 36 (62%) had an unfavorable evolution. Fourteen (24.1%) patients had compartment syndrome, with a significant risk association between 0 and 12 years old (p = 0.019). Two factors significantly contributed to unfavorable evolution: the timing from the bite to medical care being ≥6 hours and additional antivenom therapy needed. We conclude that the younger the patient, the smaller body segment affected, leading to disproportionality between the affected area and the amount of inoculated venom, contribute to more frequent local manifestations and complications in children rather than adults. Because of the relationship between body area and vascular volume in children differs from that in adults, the same volume of venom inoculated by snakes will be disproportionate in these two groups. Therefore, in the treatment of pediatric patients, increasing the volume of antivenom therapy is possibly necessary. Furthermore, as in adults, six hours between the bite to medical care increases the risk of complications and mortality.
Subject(s)
Humans , Child , Snake VenomsABSTRACT
Human metapneumovirus (hMPV) is a paramyxovirus that causes airway infections. hMPV symptoms range from mild infections of the upper respiratory tract to infections as serious as bronchiolitis and pneumonia. From 2018 to 2019, there was a high incidence of severe acute respiratory syndrome (SARS) in the State of Goiás with a relative increase in hMPV incidence. This study aimed to assess the hMPV epidemiology of cases treated at tertiary hospitals of Goiás, as there are not significant published data from hMPV infection in Brazil. We performed a retrospective and descriptive analysis of a case series of patients infected with hMPV diagnosed by PCR (16 individuals), through medical records review from 2017 to 2019. The observed age distribution was bimodal, with the disease affecting individuals at extremes of age (median of 3.5 years old in the first stratum and median of 52 years in the second stratum). The time between the onset of flu-like symptoms and the first medical assessment had an average of 5 days. The most frequent severe symptoms were respiratory distress/dyspnea and oxygen saturation <95% (93.7% as media), even in patients without comorbidities. The most frequent complications were acute renal failure (18.7%) and healthcare-associated infections (43.7%). Death occurred in 37.5% of patients. hMPV may cause upper and lower respiratory tract infections in patients of all age groups, but the symptomatic disease occurs more frequently at extremes of age. In the pandemic caused by a new coronavirus (SARS-CoV-2), which is known to lead to influenza-like and SARS, the differential diagnosis of the etiologic agent becomes paramount.