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Este estudo objetivou avaliar os potenciais efeitos adversos nos rins associado ao tratamento de longo prazo com lítio em pacientes com transtorno bipolar, a partir de uma revisão integrativa literatura. Os artigos foram identificados nas bases de dados SciELO, Medline (Pubmed) e Biblioteca Virtual em Saúde (BVS), publicados entre 2010 e 2021. Aplicados os critérios de inclusão e exclusão, identificaram-se 18 artigos para a análise. Verificou-se que o tratamento com lítio durante um período prolongado está associado à redução da taxa de filtração glomerular, porém, outras variáveis devem ser consideradas como idade e comorbidades associadas. Por outro lado, não foi associado evolução da doença renal crônica em estágio terminal por uso do medicamento. A investigação dos estudos revelou que a droga em doses terapêuticas e com monitoramento laboratorial contínuo não demonstrou toxicidade ou efeitos colaterais severos nos rins sendo a sua descontinuação relacionada com exarcebações do humor. [au]
This study aimed to assess the potential adverse effects on the kidneys associated with long-term lithium treatment in patients with bipolar disorder, based on an integrative literature review. The articles were identified in the SciELO, Medline (Pubmed) and Virtual Health Library (VHL) databases, published between 2010 and 2021. After applying the inclusion and exclusion criteria, 18 articles were identified for analysis. It was found that treatment with lithium for a prolonged period is associated with a reduction in the glomerular filtration rate, however, other variables must be considered, such as age and associated comorbidities. On the other hand, evolution of end-stage chronic kidney disease due to drug use was not associated. The investigation of the studies revealed that the drug at therapeutic doses and with continuous laboratory monitoring did not show toxicity or severe side effects in the kidneys and its discontinuation was related to mood exacerbations. [au]
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Objective:To investigate the efficacy of quetiapine fumarate combined with lithium carbonate in the treatment of bipolar disorder and its effect on cognitive function.Methods:Sixty patients with bipolar disorder, who received treatment in Zhuji Fifth People's Hospital from January 2017 to December 2019, were included in this study. They were randomly assigned to receive either lithium carbonate (control group, n = 30) or quetiapine fumarate combined with lithium carbonate treatment (combined treatment group, n = 30). All patients received 4 weeks of treatment. Manic and depressive symptoms pre- and post-treatment, clinical efficacy, cognitive function, and adverse reactions were compared between the two groups. Fasting venous blood was taken before and 4 weeks after treatment to measure superoxide dismutase (SOD), malondialdehyde (MDA), catalase (CAT), and glutathione peroxidase (GSH-Px) levels. Results:The scores of the Bech-Rafaelsdn Mania Rating Scale (BRMS) and the Hamilton Rating Scale for Depression (HAMD) in each group were significantly decreased after treatment compared with before treatment ( t = 10.39, 12.47, both P < 0.001). The score of the Mini-Mental State Examination in each group significantly increased after treatment compared with before treatment ( t = 8.36, 14.52, both P < 0.001). The scores of BRMS and HAMD post-treatment were significantly lower in the combined treatment group than in the control group ( t = 5.86, 5.54, both P < 0.001). The score of MMSE post-treatment was significantly higher in the combined treatment group than in the control group ( t = 2.40, P = 0.020). The response rate was significantly higher in the combined treatment group than in the control group ( Z = 2.16, P = 0.030). After treatment, serum MDA level significantly decreased in each group compared with before treatment ( t = 8.72, 15.47, both P < 0.001). After treatment, SOD, CAT and GSH-Px levels were significantly increased in each group compared with before treatment (SOD: tcontrol group = 2.84, P = 0.006, tcombined treatment group = 4.05, P < 0.001; CAT: tcontrol group = 5.20, P < 0.001, tcombined treatment group = 9.86, P < 0.001; GSH-Px: tcontrol group = 2.67, P = 0.010, tcombined treatment group = 3.71, P = 0.001). Serum MDA level post-treatment was significantly lower in the combined treatment group than in the control group ( t = 12.38, P < 0.001). Serum SOD and CAT levels post-treatment were significantly higher in the combined treatment group than in the control group ( tSOD = 2.24, P = 0.029; tCAT = 2.72, P = 0.009). There was no significant difference in the incidence of adverse reactions between the combined treatment and control groups [20.00% (6/30) vs. 16.67% (5/30), χ2 = 1.02, P = 0.907). Conclusion:Quetiapine fumarate combined with lithium carbonate can greatly improve clinical symptoms and cognitive function and reduce the over-activation of oxidative stress in patients with bipolar disorder. The combined therapy is of certain clinical application value.
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Objective:To investigate the efficacy of magnesium valproate versus lithium carbonate in the treatment of bipolar disorder and their effects on serum indexes and quality of life. Methods:80 patients with bipolar disorder treated in the Fifth People's Hospital of Zhuji City from March 2017 to May 2020 were included in this study. They were randomly assigned to receive either lithium carbonate (control group, n = 40) or magnesium valproate (treatment group, n = 40) for 3 months. Efficacy,serum indexes, and quality of life were compared between the two groups. Results:Total effective rate was significantly higher in the observation group than in the control group [95.0% (38/40) vs. 75.0% (30/40), χ2 = 6.28, P = 0.012]. There were no significant differences in tumor necrosis factor-α, uric acid, total bilirubin, and albumin levels between the two groups (all P > 0.05). Tumor necrosis factor-α and uric acid levels in each group were decreased after treatment compared with before treatment (both P < 0.001). Total bilirubin and albumin levels in each group were increased after treatment compared with before treatment (both P < 0.001). Tumor necrosis factor-2 and uric acid levels measured after treatment were (136.5 ± 6.2) ng/L and (307.9 ± 15.2) μmol/L, respectively in the observation group, which were significantly lower than those in the control group [(148.9 ± 7.5) ng/L, (335.6 ± 18.9) μmol/L in the control group, t = 12.20, 7.22, both P < 0.001]. Total bilirubin and albumin levels measured after treatment were (11.0 ± 2.3) μmol/L and (45.5 ± 3.6) g/L, respectively in the observation group, which were significantly higher than those in the control group [(8.4 ± 2.1) μmol/L, (42.8 ± 3.0) g/L, t = 5.28, 3.64, both P < 0.001). There were no significant differences in scores of all dimensions of quality of life between the two groups before treatment (all P > 0.05). Scores of all dimensions of quality of life in each group increased after treatment compared with befor treatment (all P < 0.001). Scores of physical functioning, physical role functioning, bodily pain, vitality, social role functioning, emotional role functioning, and mental health measured after treatment were (75.2 ± 4.4) points, (71.9 ± 4.6) points, (76.2 ± 4.7) points, (71.8 ± 3.9) points, (66.8 ± 4.0) points, (75.9 ± 4.4) points, (70.5 ± 3.9) points, and (69.9 ± 4.0) points respectively in the observation group, which were significantly higher than those in the control group [(68.0 ± 4.0) points, (65.5 ± 4.3) points, (69.8 ± 4.0) points, (66.5 ± 3.5) points, (61.8 ± 3.5) points, (68.1 ± 4.0) points, (64.1 ± 3.6) points, (63.3 ± 3.9) points, t = 7.66, 6.43, 6.56, 6.40, 5.95, 8.30, 7.63, 7.47, all P < 0.001]. Conclusion:Magnesium valproate for the treatment of bipolar disorder can improve the antioxidant capacity, inhibit immune-inflammatory injury, improve abnormal metabolism, effectively control the symptoms of depression and mania,and improve the quality of life. Magnesium valproate is more effective than lithium carbonate in the treatment of bipolar disease.
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OBJECTIVE@#To explore the treatment conditions of acid decalcified specimens and improve the poor quality of sections and unclear structure of hematoxylin-eosin (HE) staining caused by the change in pH in tooth and hard tissue after acid decalcification.@*METHODS@#A total of 20 cases of oral pathological specimens that contain hard tissues were decalcified and treated with routine treatment, concentrated ammonia water immersion treatment, and saturated lithium carbonate solution immersion treatment. The quality and HE staining effects of hard tissue sections treated with different methods were compared.@*RESULTS@#Compared with routine treatment, lithium carbonate saturated solution treatment showed complete sections. Hematoxylin is strongly stained, the nucleus is clear, and the cytoplasm is bright.@*CONCLUSIONS@#Soaking acid decalcified specimens in lithium carbonate saturated solution before embedding in dehydration can neutralize the acidic environment of the tissue. The quality of sections and HE staining effect are improved and are suitable for the pretreatment of acid decalcified tissue samples of oral pathology.
Subject(s)
Eosine Yellowish-(YS) , Hematoxylin , Staining and Labeling , ToothABSTRACT
Objective To study the clinical effect of aripiprazole combined with lithium carbonate in the treatment of acute mania .Methods 72 patients with acute mania were selected in this research .According to the order of admission,the patients with odd numbers were selected as the control group (n=36),and the patients with even numbers were selected as the observation group (n=36).The control group was treated with clozapine combined with lithium carbonate ,the observation group was treated by aripiprazole combined with lithium carbonate .The safety and efficacy of the treatment were evaluated by BRMS score , effective rate , incidence rate of adverse reaction etc .Results After treatment for 1 week,2 weeks,the BRMS scores of the observation group were (21.23 ±2.22)points and (20.02 ±2.12)points,which were significantly lower than those of the control group (t=4.0390,4.0025,all P<0.05).After treatment for 4 and 8 weeks,the BRMS scores of the two groups were similar .The effective rate of the observation group was 94.44%,which of the control group was 91.67%,the difference was not statistically signifi-cant (P>0.05).The incidence rate of adverse reactions of the observation group was 19.44%,which was significantly lower than 41.67% of the control group,the difference was statistically significant (χ2 =11.6446,P<0.05) .Conclusion Aripiprazole combined with lithium carbonate has similar effect with clozapine combined with lithium carbonate in the treatment of acute mania ,but the combination therapy of aripiprazole and lithium carbonate can effec -tively alleviate the symptoms of the disease ,and with less adverse reaction ,high safety,which can be promoted and applicated in clinical .
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Objective To compare therapeutic effects of lithium carbonate administration (LCA) given in 2 methods and combined with 131I treatment in patients with incipient Graves disease (IGD) accompanied by leukopenia.Methods From January 2014 to January 2016,192 IGD patients with leukopenia were enrolled in this retrospective study,including 49 males,143 females (average age:(39.65 ± 12.18) years).All patients did not receive antithyroid drugs (ATD) therapy and were divided into 3 groups by random number table method:group A(131I treatment plus LCA given at the same time for 2 weeks;n=65),group B (LCA given at a week before and after 131I treatment;n=67),control group (only treated with 131I;n=60).Cure rate (3 and 6 months after treatment),WBC (2 weeks,1,3 and 6 months after treatment) and adverse reaction rate (ADR;within 2 weeks after treatment) of 3 groups were analyzed before and after treatment.One-way analysis of variance,the least significant difference t test,x2 test were used.Results Compared with control group,group A and group B showed higher cure rates (3 months after treatment:87.7％ (57/ 65),88.1％(59/67),70.0％(42/60);6 months:89.2％(58/65),89.6％(60/67),71.7％(43/60);x2 values:9.05,9.58,both P＜0.05),higher increasing rates of WBC (3 months after treatment:(38.9± 5.1)％,(39.8±6.3)％,(20.2±3.3)％;F=19.87,t values:12.15,11.56,all P＜0.01),lower ADR (3.1％(2/65),14.9％ (10/67),30.0％(18/60);x2=17.19,P＜0.05).The ADR of group A was lower than that of group B (x2=4.26,P＜0.05).Conclusion For IGD patients with leukopenia and normal kidney function,the treatment of LCA combined with 131I at the same time for 2 weeks is safe and effective,and patients have less ADR.
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El uso de litio es tan antiguo como su historia generándose en el tiempo voces detractoras e como importantes defensores. En Ecuador, no está exenta esta controversia soslayándose el uso de litio para tratar cuadros el trastorno bipolar, eventos suicidas y como coadyuvante en casos de depresión resistente al tratamiento, pese a ser un medicamento básico de comprobada eficacia en estas patologías. Un manejo y monitoreo adecuados, evitaría su sustitución por medicamentos de mayor costo sobre todo para el Sistema Nacional de Salud Pública, que asiste a un importante segmento poblacional de bajos recursos económicos.(AU)
The use of lithium is as old as its history, generating in time detractor voices and as important defenders. In Ecuador, this controversy is not exempt from the use of lithium to treat bipolar disorder, suicidal events and as an adjuvant in cases of treatment-resistant depression, despite being a basic drug with proven efficacy in these pathologies. Adequate management and monitoring would avoid its substitution by drugs of greater cost, especially for the National Public Health System, which assists an important segment of the population with low economic resources. (AU)
Subject(s)
Humans , Animals , Male , Female , Adult , Mental Health , Lithium Carbonate , Behavioral Disciplines and Activities , Psychological Phenomena , Lithium , Mental Health ServicesABSTRACT
Resumen Introducción. El litio es el medicamento de elección para el tratamiento del trastorno afectivo bipolar. Objetivo. Determinar el perfil de uso y las reacciones secundarias del litio en pacientes con trastorno afectivo bipolar en Colombia. Materiales y métodos. Se hizo un estudio observacional de cohorte retrospectiva entre el 1° de enero y el 31 de diciembre de 2013, en pacientes con diagnóstico de trastorno afectivo bipolar tratados con carbonato de litio en 25 ciudades colombianas. Se evaluaron las variables sociodemográficas, las dosis del litio, la medicación simultánea con otros fármacos, las interacciones medicamentosas y las reacciones adversas. Se hizo un análisis multivariado utilizando el programa SPSS 22.0®. Resultados. La edad promedio de los 331 pacientes fue de 44,5 ± 13,9 años, 59,2 % de ellos eran mujeres, la dosis promedio de litio fue de 898 ± 294 mg/día, y 22 % recibía dosis inferiores a las recomendadas; los participantes habían recibido el medicamento durante 38,0 ± 39,5 meses en promedio (rango: 12-159 meses), y solo a 13,5 % de ellos se les había hecho el análisis de litio en sangre. El 71,3 % recibía otros medicamentos como tratamiento coadyuvante para el trastorno afectivo bipolar, especialmente clozapina (16,6 %) y ácido valproico (16,6 %). Las principales enfermedades concomitantes fueron el hipotiroidismo (18,1 %) y la hipertensión arterial (12,7 %). Se encontraron 390 interacciones medicamentosas potencialmente tóxicas y se reportaron reacciones secundarias en 1,2 % de los casos. Se encontró una asociación estadísticamente significativa con un menor riesgo de recibir tratamiento combinado en pacientes tratados en las ciudades de Bogotá (odds ratio, OR=0,4; p=0,025), Cartagena (OR=0,3; p=0,015) e Ibagué (OR=0,3; p=0,025). Conclusiones. El litio se administraba en las dosis e intervalos recomendados, pero un porcentaje significativo recibía dosis inferiores a las recomendadas y no fue posible contrastar el efecto con los niveles de litio en suero. Se debe mejorar el reporte de reacciones adversas y la medición de los niveles de litio en suero en los pacientes con trastorno afectivo bipolar en Colombia.
Abstract Introduction: Lithium is the drug of choice for the treatment of bipolar affective disorder. Objective: To define lithium therapeutic profile and adverse reactions to its use in patients with bipolar affective disorder in Colombia. Materials and methods: We conducted an observational retrospective cohort study between January 1 and December 31, 2013, which included patients with a diagnosis of bipolar disorder treated with lithium carbonate in 25 Colombian cities; we evaluated socio-demographic variables, lithium dose, co-medication, drug interactions and adverse reactions. A multivariate analysis was done using SPSS 22.0. Results: The 331 patients had an average age of 44.5 ± 13.9 years; 59.2% were women. The mean dose of lithium was 898 ± 294 mg/day; 22% received doses lower than recommended, and patients had received lithium for 38.0 ± 39.5 months (range: 12-159 months). Lithium levels in blood had been measured only in 13.5% of patients; 71.3% of them had received adjuvant therapy for bipolar disorder with other drugs, especially clozapine (16.6%) and valproic acid (16.6%). The main comorbidities were hypothyroidism (18.1%) and hypertension (12.7%); 390 potentially toxic drug interactions were found, and adverse reactions were reported in 1.2% of patients. A statistically significant association was found between a lower risk of combination therapy and receiving treatment in the cities of Bogotá (OR=0.4, p=0.025), Cartagena (OR=0.3, p=0.015) and Ibagué (OR=0.3, p=0.025). Conclusion: Lithium was generally used at recommended doses and intervals, but a significant percentage of patients received lower doses than those recommended, and it was not possible to compare with lithium levels in blood. Adverse reactions and blood lithium levels reporting should be improved in patients with bipolar disorder in Colombia.
Subject(s)
Humans , Bipolar Disorder/drug therapy , Valproic Acid/therapeutic use , Lithium Carbonate , Hypothyroidism/complications , Bipolar Disorder/diagnosis , Retrospective Studies , Valproic Acid/chemistry , Lithium Carbonate/therapeutic use , ColombiaABSTRACT
Objective To investigate the influence of magnesium valproate and quetiapine separately combined with lithium carbonate on BRMS scores,PANSS scores and adverse effects of patients with manic episode of bipolar disorder in puberty. Methods 100 patients with manic episode of bipolar disorder in puberty were chosen and randomly divided into two groups according to the digital table. Group A ( 50 children ) was given magnesium valproate,and group B (50 children) was given quetiapine on the basis of lithium carbonate. The clinical efficacy,the BRMS score,PANSS score and WCST score before and after treatment and the incidence of adverse effects of the two groups were compared. Results There was no significant difference in clinical efficacy between the two groups (94. 00% vs. 90. 00%),(χ2 =1. 31,P>0. 05). After treatment for 2 weeks,the BRMS score,PANSS score and WCST score of group B were significantly better than those of group A and before treatment(t=2. 45,3. 16;2. 71,3. 26,2. 79, 3. 36,all P<0. 05). 6 weeksafter treatment,there were no significant differences in the BRMS score,PANSS score and WCST score between the two groups(t=1. 20,1. 08,1. 19,all P<0. 05). There was no significant difference in the incidence rate of adverse effects between the two groups(χ2 =1. 49,P>0. 05). Conclusion Two kinds of bigeminy drug therapy in the treatment of patients with manic episode of bipolar disorder in puberty possess the clinical effects and safety,and quetiapine combined with lithium can help to shorten the onset time and higher the compliance degree.
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Objective To investigate the influence of magnesium valproate and quetiapine separately combined with lithium carbonate on BRMS scores,PANSS scores and adverse effects of patients with manic episode of bipolar disorder in puberty. Methods 100 patients with manic episode of bipolar disorder in puberty were chosen and randomly divided into two groups according to the digital table. Group A ( 50 children ) was given magnesium valproate,and group B (50 children) was given quetiapine on the basis of lithium carbonate. The clinical efficacy,the BRMS score,PANSS score and WCST score before and after treatment and the incidence of adverse effects of the two groups were compared. Results There was no significant difference in clinical efficacy between the two groups (94. 00% vs. 90. 00%),(χ2 =1. 31,P>0. 05). After treatment for 2 weeks,the BRMS score,PANSS score and WCST score of group B were significantly better than those of group A and before treatment(t=2. 45,3. 16;2. 71,3. 26,2. 79, 3. 36,all P<0. 05). 6 weeksafter treatment,there were no significant differences in the BRMS score,PANSS score and WCST score between the two groups(t=1. 20,1. 08,1. 19,all P<0. 05). There was no significant difference in the incidence rate of adverse effects between the two groups(χ2 =1. 49,P>0. 05). Conclusion Two kinds of bigeminy drug therapy in the treatment of patients with manic episode of bipolar disorder in puberty possess the clinical effects and safety,and quetiapine combined with lithium can help to shorten the onset time and higher the compliance degree.
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Machado-Joseph disease (MJD) or spinocerebellar ataxia type 3 (SCA3) is an autosomal dominant neurodegenerative disorder caused by expansion of the polyglutamine domain of the ataxin-3 (ATX3) protein. MJD/SCA3 is the most frequent autosomal dominant ataxia in many countries. The mechanism underlying MJD/SCA3 is thought to be mainly related to protein misfolding and aggregation leading to neuronal dysfunction followed by cell death. Currently, there are no effective treatments for patients with MJD/SCA3. Here, we report on the potential use of lithium carbonate and coenzyme Q10 to reduce cell death caused by the expanded ATX3 in cell culture. Cell viability and apoptosis were evaluated by MTT assay and by flow cytometry after staining with annexin V-FITC/propidium iodide. Treatment with lithium carbonate and coenzyme Q10 led to a significant increase in viability of cells expressing expanded ATX3 (Q84). In addition, we found that the increase in cell viability resulted from a significant reduction in the proportion of apoptotic cells. Furthermore, there was a significant change in the expanded ATX3 monomer/aggregate ratio after lithium carbonate and coenzyme Q10 treatment, with an increase in the monomer fraction and decrease in aggregates. The safety and tolerance of both drugs are well established; thus, our results indicate that lithium carbonate and coenzyme Q10 are good candidates for further in vivo therapeutic trials.
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Humans , Ataxin-3/drug effects , Cell Death/drug effects , Lithium Carbonate/pharmacology , Machado-Joseph Disease , Repressor Proteins/drug effects , Ubiquinone/analogs & derivatives , Cell Differentiation/drug effects , Cell Proliferation/drug effects , Machado-Joseph Disease/drug therapy , Ubiquinone/pharmacologyABSTRACT
Because adenine is effective for managing cases of radiation-induced and drug-induced leukopenia, it may be effective in cases of antipsychotic-induced leukopenia and neutropenia. Here, we report our experience with patients with leukopenia and neutropenia caused by an antipsychotic overdose or discontinuation of lithium carbonate, in whom adenine administration ameliorated the white blood cell and neutrophil counts. The progress of patients suggests that adenine is effective in cases of leukopenia and neutropenia associated with lithium carbonate discontinuation and an antipsychotic overdose.
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Humans , Adenine , Antipsychotic Agents , Leukocytes , Leukopenia , Lithium Carbonate , Lithium , Neutropenia , NeutrophilsABSTRACT
Objective:To evaluate the quality status of lithium carbonate tablets and lithium carbonate sustained-release tablets. Methods:The samples were examined in accordance with the statutory standard,and the exploratory studies were carried out. The results were statistically analyzed. Results:In accordance with the statutory standard,among 120 batches of samples, only one was unqualified in dissolution,and the others were qualified. The qualified rate was 99. 2% . Conclusion:The quality of the most products meets the current standard and the quality evaluation standard needs to be improved.
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Objective To investigate the effets of three mood stabilizers on ouabain?induced ERK1/2 phosphorylation in astrocytes. Methods As?trocytes were treated with different agents and divided into different groups accordingly,namely,the control group with saline,the group with oua?bain,the group with mood stabilizers(lithium carbonate,carbamazepine,sodium valproate)and the group with ouabain+mood stabilizers. The phosphorylation of ERK1/2 in each group was analyzed by Western blot. Results Compared with saline and mood stabilizer groups,the phosphoryla?tion of ERK1/2 was increased in the ouabain group,with statistical significance(P<0.05). There was no significant difference in ERK1/2 phosphoryla?tion between the group with ouabain+mood stabilizers and the control or mood stabilizer group. Conclusion The three kinds of mood stabilizers can inhibit ouabain?induced ERK1/2 phosphorylation in astrocytes.
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Objective:To establish a method for the determination of chloride and sulfate in lithium carbonate crude drug by sup-pressed ion chromatography. Methods:The analysis column and the guard column was Thermo IonPac AS11(250 mm × 4 mm) and IonPac AG 11(50 mm ×4 mm), respectively. Potassium hydroxide solution(10 mmol·L-1) generated by an eluent generator(EG) was used as the eluent at a flow rate of 1. 0 ml·min-1 . And the temperature of column and conductivity cell was 30℃ and 35℃, re-spectively. The suppressor electric current was 36 mA, and the injection volume was 10 μl. Results:The linear range of chloride ion and sulfate ion was 1. 0-20μg·ml-1 with r of 0. 995 1 and 0. 997 3,respectively, and the recovery was 106. 6%(RSD=2. 6%,n=6) and 100. 3%(RSD=1. 9%,n=6), respectively. Conclusion:The method is accurate and reliable, and can be used in the determina-tion of chloride and sulfate in lithium carbonate crude drug.
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Introdução: a cefaleia em salvas (CS) é um subtipo de cefaleia primária caracterizado por crises de dor entre 15 e 180 minutos diárias por semanas a meses, geralmente intercalados por períodos de remissão. As crises álgicas são muito intensas, de localização orbital ou periorbital, associadas à sintomatologia de disfunção autonômica. Apesar de sua singular apresentação clínica, a CS permanece afecção pouco reconhecida e subdiagnosticada. Objetivos: descrever e discutir os desafios diagnósticos e terapêuticos da CS a partir de casos clínicos. Material e método: trata-se de uma série de cinco casos de CS em acompanhamento clínico. Resultados: dos 467 pacientes assistidos em ambulatório neurológico, cinco possuíam diagnóstico de CS, correspondendo a 1,07% do total. A apresentação clínica variou pouco em relação à descrição da literatura, com predomínio em homens e da forma episódica, além de haver grande latência entre seu surgimento e o diagnóstico. Conclusão: mesmo em centro terciário de atendimento neurológico, o número de pacientes diagnosticados é pequeno, colaborando para o desconhecimento a respeito da CS, o que contribui para o seu atraso diagnóstico e tratamento específico.
Introduction: cluster headaches (CS) are a subtype of primary headache disorder characterized by daily pain attacks of 15-180 minutes for weeks to months, usually interspersed with periods of remission. Painful crises are very intense, of periorbital or orbital location, associated with symptoms of autonomic dysfunction. Despite its unique clinical presentation, CS remains under-recognized and underdiagnosed. Objectives: To describe and discuss the diagnostic and therapeutic challenges of CS based on clinical cases. Methods: this is a series of fivecases of CS under clinical monitoring. Results: Of the 467 patients treated at the neurological clinic five had a diagnosis of CS, corresponding to 1.07% of the total. The clinical presentation varied little in relation to the description in the literature; it affected predominantly men, episodically. Time elapsed between onset and diagnosis was usually long. Conclusion: Even in a tertiary care neurological center, the number of diagnosed patients is small, which reflects on ignorance about CS and contributes to late diagnosis and lack of specific treatment.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Cluster Headache/diagnosis , Headache/diagnosis , Headache/therapyABSTRACT
Background: Lithium is routinely used to treat mania and other psychiatric disorders. It prevents the mood swing changes in bipolar disorders and the treatment is usually prolonged. Aim of current study was to observe histological changes in the thyroid gland of lithium carbonate treated albino rats. Methods: Sixty albino rats were taken and divided into two groups, group A (control group) of 15 animals, were fed with normal diet and group B of 45 animals, were fed normal diet along with lithium carbonate at the dose of 30mg/kg body weight daily. The animals were sacrificed at four, eight and twelve week’s interval, 5μm sections prepared and stained with haematoxylin and eosin stain. Results: Microscopic changes in thyroid gland of albino rats were evident after 8 weeks of drug administration which include marked pleomorphism, shrinkage in size of thyroid follicles, excess of colloid and marked vacuolations in acini. At 12th week of study, follicles were found both macro and micro follicular, with variable lining epithelium and hyperchromatic nuclei. Lining epithelium of some follicles was disrupted. The stroma was infiltrated with lymphocytes and eosinophils and there were some interfollicular hemorrhages. Conclusions: Lithium given over prolonged period will cause macro and micro follicular goiter with hyperplastic epithelium and hyper chromatic nuclei, hyperplasia of stroma with increased vascularity, sometimes hemorrhages and finally may lead to thyroiditis like picture. So, it is advised that patients on lithium therapy should be periodically evaluated for thyroid dysfunction.
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OBJECTIVES: this study featured patients with affective bipolar disorder who were making use of lithium and received care at an outpatient care center located in a country town in the state of Sao Paulo in 2009; it assessed the adherence and knowledge of these patients in relation to the medication prescribed to them and verified the proportion of blood tests performed per year in the service, for each individual, to measure lithium levels in the blood. METHOD: descriptive study with quantitative approach, involving 36 participants. Structured interviews and review of medical records were used for data collection and descriptive statistics for data analysis. RESULTS: difficulties in reporting the dosage of the medication prescribed and a high rate of non-adherence were identified among the participants. None of the participants in the study was submitted to two tests a year to measure lithium levels in the blood, which is the minimum proportion of tests recommended by the literature for maintenance treatment using lithium carbonate. CONCLUSION: this study highlights the critical factors for the promotion of patients' safety in monitoring lithium drug therapy. .
OBJETIVOS: este estudo teve como objetivo caracterizar pacientes com transtorno afetivo bipolar, em uso de lítio, atendidos no ano 2009 em um serviço ambulatorial do interior de São Paulo, Brasil; avaliar a adesão e conhecimento dos mesmos sobre medicamentos prescritos e verificar a proporção de litemias/ano realizadas, no serviço, para cada indivíduo. MÉTODO: trata-se de estudo descritivo, com abordagem quantitativa, do qual participaram 36 pessoas. Foram utilizadas entrevistas estruturadas e revisão de prontuários para coleta de dados e estatística descritiva para análise dos mesmos. RESULTADOS: entre os participantes, foram identificadas dificuldades em relatar a dose dos fármacos prescritos e alta taxa de não adesão. Em nenhum participante do estudo foi atingida a proporção de duas litemias/ano, que representa a quantidade mínima de litemias preconizada pela literatura para o tratamento de manutenção com carbonato de lítio. CONSIDERAÇÕES FINAIS: este estudo aponta fatores críticos na promoção da segurança do paciente no seguimento da terapêutica medicamentosa com lítio. .
OBJETIVOS: este estudio caracterizó pacientes con trastorno afectivo bipolar, tratadas con litio, atendidos en el año de 2009 en un servicio de ambulatorio del interior del estado de Sao Paulo, en Brasil; evaluó la adhesión y conocimiento de los mismos sobre medicamentos prescritos y verificó la proporción de litemias/año realizadas, en el servicio, para cada individuo. MÉTODO: se trata de estudio descriptivo, con abordaje cuantitativo, del cual participaron 36 personas. Fueron utilizadas entrevistas estructuradas y revisión de fichas para recolección de datos y estadística descriptiva para análisis de los mismos. RESULTADOS: entre los participantes, fueron identificadas dificultades en relatar la dosis de los fármacos prescritos y una alta tasa de no adhesión. En ningún participante del estudio fue alcanzada la proporción de dos litemias/año, que representa la cantidad mínima de litemias preconizada por la literatura para el tratamiento de mantenimiento con carbonato de litio. CONCLUSIÓN: este estudio apunta factores críticos para la promoción de la seguridad del paciente en el seguimiento de la terapéutica medicamentosa con litio. .
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Bipolar Disorder/blood , Bipolar Disorder/drug therapy , Drug Monitoring , Health Knowledge, Attitudes, Practice , Lithium Carbonate/blood , Lithium Carbonate/therapeutic use , Medication Adherence/statistics & numerical data , Cross-Sectional Studies , Retrospective StudiesABSTRACT
Objective To observe the clinical effect of lithium carbonate on hyperthyroidism.Methods Forty-seven cases of hyperthyroidism with abnormal hepatic function and/or leucopenia were recruited from January 2010 to January 2012.Thyroid function,adverse reactions,and clinical outcome of patients treated with lithium carbonate were observed and recorded before and after treatment.Results Thyroid function,liver function,and leucopenia in all patients were improved markedly after treatment.Among the treated patients,9 cases resulted in complete remission and had the drug discontinued,11 cases received radioactive iodine therapy afterwards,6 cases underwent surgical treatment,16 cases continued to use the same drug,and 5 cases were lost during follow-up.No obvious adverse reaction appeared during the treatment.Conclusions Lithium carbonate can be effectively used in patients with hyperthyroidism complicated by leukopenia or liver damage.It is also indicated during preparation for radioactive iodine or surgical treatment in patients with thyrotoxicosis.
ABSTRACT
[Summary] Lithium carbonate has been used as a psychiatric drug with some adverse effects such as hypothyroidism and leukocytosis.The adverse effects have been exploited for the treatment of hyperthyroid patients in particular conditions.It might be an alternative therapy for controlling hyperthyroidism in patients who can not tolerate or do not respond to thionamides or suffer from leukopenic condition.But it is important that monitoring serum lithium level,using smaller dose,and avoiding serious side-effects during the therapy of lithium carbonate should be carried out.