Síndrome de abstinência em Unidade de Tratamento Intensivo Pediátrico: protocolo de revisão sistemática / Abstinence syndrome in Pediatric Intensive Care Unit: a systematic review protocol

OBJETIVO: Verificar qual o tratamento mais indicado para a prevenção e redução dos sinais e sintomas de abstinência em crianças criticamente doentes por meio de uma revisão sistemática da literatura mundial. MÉTODO: A revisão sistemática será conduzida conforme a metodologia PRISMA e Cochrane, com registro no PROSPERO, sob o número de ID CRD42021274670, nas respectivas bases de dados PubMed, LILACS, Embase, Web of Science, Cochrane, CINAHL, Cochrane Database Systematic Review e CENTRAL. As buscas serão realizadas por dois avaliadores independentes, um terceiro realizará o intermédio se necessário. Os dados serão inseridos no programa de software Zotero que irá excluir os artigos duplicados, após o material selecionado será transferido para planilha Excel em instrumento próprio. Os estudos serão classificados quanto ao seu nível de evidência, viés e fator de risco. Os resultados serão analisados e tabulados e discutidos a fim de melhor compreensão dos resultados. Se possível, serão realizadas meta-análises para os resultados agregados.

OBEJECTIVE: To verify the most appropriate treatment for the prevention and reduction of the signs and symptoms of abstinence in critically ill children through a systematic review of the world literature. METHOD: The systematic review will be conducted according to the PRISMA and Cochrane methodology, with registration at PROSPERO, under the ID number CRD42021274670, in the respective databases, PUBMed, LILACS, Embase, Web of Science, Cochrane, CINAHL, Cochrane Database Systematic Review, and CENTRAL, searches will be carried out by two independent evaluators, and a third party will perform the intermediate if necessary. The data will be entered into the Zotero software program that will delete duplicate articles after the selected material is transferred to an Excel spreadsheet on its instrument. The studies will be classified according to their level of evidence, bias, and risk factors. The results will be analyzed, tabulated, and discussed to understand the results better. If possible, meta-analyzes will be carried out for the aggregated results.

Dependencia y abstinencia de Zolpidem. Reporte de un caso de convulsiones generalizadas

El zolpidem es un agente hipnótico no benzodiacepínico utilizado con suma frecuencia en el tratamiento del insomnio e indicado para emplearlo en el corto plazo. No está indicado para el tratamiento crónico de los trastornos del sueño, pese a lo cual se evidencia en la práctica clínica que gran cantidad de pacientes lo reciben por arios. Si bien se ha descrito que presenta un mejor perfil de efectos adversos que las benzodiacepinas y que genera menos riesgo de dependencia y abstinencia que estas, existen sendos reportes de casos de dependencia y abstinencia de zolpidem. Se presenta el reporte de un caso de convulsiones tónico-clónicas generalizadas por abstinencia a dosis de 300 mg/día de Zolpidem y se realiza una breve revisión de la literatura.

Zolpidem is a non-benzodiazepine hypnotic agent used most frequently in the treatment of insomnia, indicated for short-term use. It is not indicated for the chronic treatment of sleep disorders, despite which there is evidence in clinical practice that a large number of patients receive it for years. Although it has been described that it presents a better profile of adverse effects than benzodiazepines and that it generates a lower risk of dependence and withdrawal than these, there are significant reports of cases of dependence and withdrawal from zolpidem. A report of a case of generalized tonic-clonic seizures due to with drawal at a dose of 300 mg per day of zolpidem is presented and a brief review of the literature is carried out.

Atribuciones hacia la timidez y la soledad en niños y niñas de diferentes contextos sociales argentinos / Attributions towards shyness and unsociability in Argentinian children from different social contexts

Resumen Las atribuciones de los niños y las niñas hacia los comportamientos de retraimiento social suelen estar determinadas por el entorno sociocultural particular en el que se desarrollan e influyen en la forma en que reaccionan a las conductas de sus pares durante las interacciones sociales. El objetivo de este trabajo fue comparar dichas atribuciones hacia dos subtipos de retraimiento social (timidez y preferencia por la soledad) referidas por niños y niñas de tres contextos diferentes de Mendoza (Argentina): urbano, urbano-marginado y rural. Se llevó a cabo un estudio con 221 niños y niñas abordando jardines de infantes estatales de cada ámbito (urbano: . = 82, Mmeses= 62.33; urbano-marginado: . = 72, Mmeses= 60.47; rural: . = 67, Mmeses= 63.07). Los escolares fueron entrevistados individualmente con una serie de viñetas gráficas con personajes hipotéticos desplegando conductas sociables, tímidas, solitarias y agresivas frente a las cuales respondieron preguntas sobre sus atribuciones y percepciones en distintos aspectos. Las diferentes pruebas no paramétricas realizadas señalaron que el personaje tímido fue percibido con mayor motivación social y menor intencionalidad en su conducta que el personaje solitario en todos los grupos. No se encontraron diferencias entre los contextos en la atribución de consecuencias sociales negativas para estas conductas, aunque el grupo de escolares rurales reportó mayor preferencia afiliativa y compasión por el personaje tímido en comparación con el grupo urbano. Se discuten estos resultados considerando cómo las expectativas de socialización de cada contexto podrían influir en las percepciones de los escolares hacia el retraimiento social.

Abstract Children's attributions towards withdrawn behaviors are usually determined by the particular social milieu in which they develop and tend to influence their behaviors and reactions. The aim of this work was to compare the attributions towards two subtypes of social withdrawal (shyness and unsociability) referred by children from three different contexts in Mendoza, Argentina: urban, urban-marginalized and rural. Participants were 221 kindergarten children from these contexts (urban: n = 82, Mmonths = 62.33; urban-marginalized: n = 72, Mmonths = 60.47; rural: n = 67, Mmonths = 63.07). Children were individually interviewed with a series of graphic vignettes with hypothetical characters displaying shy and unsociable behaviors, and for comparison purposes were also assessed aggressive and socially competent behaviors. After each vignette, children were asked a series of questions designed to assess their attributions toward each behavior in six dimensions: intentionality, social motivation, affiliative preference, social status, negative impact and sympathy. The results of this study showed that young children in the three contexts were able to distinguish social withdrawal from other types of behaviors (i.e., aggressiveness and sociability). Overall, withdrawn behaviors received more positive attributions (greater affiliative preference, better social position and less negative impact) than aggressive behaviors, although they were also perceived negatively in relation to more socially competent behaviors (the latter were attributed greater affiliative preference and best position within the peer group). Furthermore, it was observed that children from the three contexts made clearly distinctions among the different forms of social withdrawal in terms of intentionality and social motivation. Specifically, they reported that compared with unsociable characters, shy ones are more socially motivated and less intentional in their behavior, evocating greater feelings of compassion. However, some peculiarities can be appreciated in each context. The results indicated that children in the urban group reported greater feelings of sympathy for the shy character in relation to the unsociable, which was not evidenced in the other groups. In addition, children from the rural sample showed a greater preference for interact with the hypothetical shy peer than with the unsociable character and this inclination was also greater when compared with the urban sample. Taken together, these results may suggest that different socialization norms and expectations would evoke different meanings and implications to the socially withdrawn manifestations. It might be possible that in urban contexts children's socialization expectations highlight extraversion and self-affirming behaviors which generate more empathetic reactions in front of passive or fearful manifestations as shyness. On the other hand, rural children may prefer peers who display shy behaviors possibly because it is in line with expectations of social cohesion and modesty that are value in this milieu. Nevertheless, no differences were found between shy and unsociable behaviors in any of the contexts in terms of social position and negative impact that they anticipated for the peer group. These results could provide some support for the idea that social withdrawal tends to be globally perceived as benign at an early age, and especially in the rural context, where it is a frequent and valued behavior. Although it is not possible with the limited variables included in this study to know which are the specific contextual aspects that affect some attributions and through what mechanisms they do so, these findings are an important starting point to continue deepening the socialization processes in urban, urban-marginalized and rural young children. This study is also one of the first to evaluate the knowledge and attributions of Argentinean children from different social context toward social withdrawal and provides new evidence on the differences in the cultural meaning and implications of withdrawn behaviors in early childhood.

The mediating effect of self-regulation fatigue between acceptance of hearing impairment and work withdrawal behavior in young and middle-aged patients with sudden deafness / 中国实用护理杂志

Objective:To explore the mediating effect of self-regulation fatigue between acceptance of hearing impairment and work withdrawal behavior in young and middle-aged patients with sudden deafness, so as to provide reference for the formulation of intervention measures for job withdrawal behavior.Methods:A cross-sectional survey was conducted to facilitate the selection of 326 young and middle-aged patients with sudden deafness who were treated in the Department of Otolaryngology, Head and Neck Surgery in the First Affiliated Hospital and the Second Affiliated Hospital of Air Force Military Medical University of the Chinese PLA from February 2021 to January 2022. The survey was carried out by general information questionnaire, the Revised Acceptance Disability Scale, the Self-Regulatory Fatigue Scale, and the Work Withdrawal Behavior Scale. Structural equation model method was used to analyze the mediating effect.Results:The acceptance of hearing impairment score in young and middle-aged patients with sudden deafness was (59.82 ± 10.99) points, the self-regulation fatigue score was (60.38 ± 8.84) points, and the work withdrawal behavior score was (39.06 ± 6.51) points. Self-regulation fatigue was negatively correlated with acceptance of hearing impairment ( r=-0.541, P<0.01). Work withdrawal behavior was negatively correlated with acceptance of hearing impairment ( r=-0.488, P<0.01), and was positively correlated with self-regulation fatigue ( r=0.587, P<0.01). Self-regulation fatigue played a partial mediating effect between the acceptance of hearing impairment and work withdrawal in young and middle-aged patients with sudden deafness, and the mediating effect ratio was 56.30%. Conclusions:The acceptance of hearing impairment can not only directly affect the work withdrawal behavior of young and middle-aged patients with sudden deafness, but also indirectly affect their work withdrawal behavior through self-regulation fatigue. Medical staff should pay attention to the internal relationship between the acceptance of hearing impairment, self-regulation fatigue and work withdrawal behaviors, so as to improve the acceptance of hearing impairment of patients, relieve their self-regulation fatigue, and avoid the occurrence of work withdrawal behaviors.

Palliative Care for End-Stage Renal Disease:A Case Report and Literature Review / 中国医学科学院学报

Since end-stage renal disease leads to a variety of problems such as disability,reduced quality of life,and mental and psychological disorders,it has become a serious public health problem around the globe.Renal palliative care integrates palliative care philosophy in the care for patients with end-stage renal disease.As a planned,comprehensive,patient-centered care,renal palliative care focuses on the patient's symptoms and needs,aiming to reduce the suffering throughout the course of the disease,including but not limited to end-of-life care.This study reports the palliative care practice for a patient on maintenance dialysis in the Blood Purification Center of Peking Union Medical College Hospital and reviews the present situation of palliative care in end-stage renal disease.

Research progress on social withdrawal in children / 中国学校卫生

Abstract@#Social withdrawal is a kind of behavioral inhibition in social situations, which may increase the risk for maladjustment, internalizing and externalizing problems, interfering with psychological development and healthy growth. With the deepening understanding in sociology of development, child social withdrawal has gradually received extensive attention from scholars across the world. Understanding the phenomenon of child social withdrawal is important for in depth follow up research. Based on the literature review, the paper aims to summarize the types, mechanisms and influencing factors of social withdrawal in children, in order to provide scientific basis for formulating prevention strategies and early intervention programs in the future.

A Case of Acute Withdrawal Symptoms Due to Unplanned Interruption of Buprenorphine Transdermal Patch: With a Discussion Including Social Aspects of Home Medical Care Patients

Introduction: Since the commercial availability of buprenorphine extended-release transdermal patches (BTDP) from the early 2010’s, the therapeutic indications for opioids have widely expanded to include chronic benign diseases. We report a case of a home health care patient with acute opioid withdrawal symptoms due to self-interruption of BTDP. Case: An 84-year-old man using home health care services due to worsening of lumbar spinal canal stenosis had been receiving analgesia with a BTDP, a mixed opioid agonist/antagonist analgesic, for the preceding five months. Since the patient's spouse thought that his pain and symptoms were gradually improving, she secretly replaced the BTDP with an NSAID patch without informing the patient. About 50 hours later, the patient experienced a variety of symptoms, including frequent urination with incontinence every five minutes, watery diarrhea, sweating, decreased blood pressure, discomfort in the feet, and insomnia. Evaluation of the Clinical Opiate Withdrawal Score (COWS) by the home health care physician indicated a score of 12, corresponding to mild withdrawal symptoms. About 12 hours after symptom onset, the severe abnormalities were barely noticeable and completely disappeared after two days. Conclusion: Few previous case reports have described withdrawal symptoms due to rapid discontinuation of BTDP. In addition to the medical considerations, we report the social issues associated with onset of the condition in a home environment. Opioid use for non-cancer pain requires medication management from a different perspective than that for cancer pain.

Amino acid metabolism characteristics of Banxia Baizhu Tianma Decoction in realizing drug withdrawal based on transcriptomic analysis / 中国中药杂志

This study aimed to demonstrate the effect of Banxia Baizhu Tianma Decoction(BBTD) on realizing withdrawal of anti-epileptic drugs and explore the relationship between BBTD and the amino acid metabolism by transcriptomic analysis in the rat model of epilepsy induced by lithium chloride-pilocarpine. The rats with epilepsy were divided into a control group(Ctrl), an epilepsy group(Ep), a BBTD & antiepileptic drug integrative group(BADIG), and an antiepileptic drug withdrawal group(ADWG). The Ctrl and Ep were given ultrapure water by gavage for 12 weeks. The BADIG was given BBTD extract and carbamazepine solution by gavage for 12 weeks. The ADWG was given carbamazepine solution and BBTD extract by gavage for the former 6 weeks, and then only given BBTD extract for the latter 6 weeks. The therapeutic effect was evaluated by behavioral observation, electroencephalogram(EEG), and hippocampal neuronal morphological changes. High-throughput sequencing was used to obtain amino acid metabolism-related differen-tial genes in the hippocampus, and the mRNA expression in the hippocampus of each group was verified by real-time quantitative polymerase chain reaction(RT-qPCR). The hub genes were screened out through protein-protein interaction(PPI) network, and Gene Ontology(GO) functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes(KEGG) pathway enrichment analysis were performed. Two ceRNA networks, namely circRNA-miRNA-mRNA and lncRNA-miRNA-mRNA, were constructed for ADWG vs BADIG. The experimental results showed that compared with those in Ep, rats in ADWG were significantly improved in the behavioral observation, EEG, and hippocampal neuronal impairment. Thirty-four amino acid metabolism-related differential genes were obtained by transcriptomic analysis, and the sequencing results were confirmed by RT-qPCR. Eight hub genes were obtained through PPI network, involving several biological processes, molecular functions, and signal pathways related to amino acid metabolism. Finally, the circRNA-miRNA-mRNA ternary transcription network of 17 circRNA, 5 miRNA, and 2 mRNA, and a lncRNA-miRNA-mRNA ternary network of 10 lncRNA, 5 miRNA, and 2 mRNA were constructed in ADWG vs BADIG. In conclusion, BBTD can effectively achieve the withdrawal of antiepileptic drugs, which may be related to the transcriptomic regulation of amino acid metabolism.

Acupuncture for treatment of tobacco withdrawal syndrome: systematic review and Meta-analysis / 中国针灸

OBJECTIVE@#To systematically review the efficacy of acupuncture for the treatment of tobacco withdrawal syndrome.@*METHODS@#The randomized controlled trials (RCTs) regarding acupuncture for treatment of tobacco withdrawal syndrome were searched in CNKI, Wanfang, VIP, SinoMed, PubMed, Cochrane, Medline and EMbase databases. The search period was from January 1st of 2011 to December 31st of 2021. After data extraction and bias risk assessment of the included literature, the Meta-analysis was performed using RevMan5.4.1 software.@*RESULTS@#Totally 23 RCTs were included, including 2 120 patients. The Meta-analysis results showed that compared with medication, acupuncture showed no significant difference at improving Fagerström test for nicotine dependence (FTND) score (MD=0.16, 95%CI: -0.08, 0.41), heaviness of smoking index (HSI) score (MD=0.11, 95%CI: -0.13, 0.36), Minnesota nicotine withdrawal scale (MNWS) score (MD=0.12, 95%CI: -0.11, 1.35), questionnaire of smoking urges (QSU) score (MD=-0.30, 95%CI: -2.78, 2.18), Hamilton depression scale (HAMD) score (MD=0.76, 95%CI: -1.54, 3.06), abstinence rate (RR=0.95, 95% CI: 0.82, 1.10) and effective rate (RR=1.01, 95%CI: 0.95, 1.07). Acupuncture was superior to sham acupuncture in reducing MNWS score (MD=-4.88, 95%CI: -5.21, -4.55, P<0.000 01). Acupuncture was superior to cognitive behavioral therapy in reducing FTND score (MD=-1.41, 95%CI: -1.74, -1.08), MNWS score (MD=-4.28, 95%CI: -5.31, -3.25) and increasing abstinence rate (RR=2.19, 95%CI: 1.39, 3.45, P<0.000 01, P<0.001).@*CONCLUSION@#Acupuncture could effectively improve tobacco withdrawal syndrome, increase abstinence rate and effective rate. Limited by the quantity and quality of the included studies, this conclusion needs to be verified by more studies.

Perder o apetite. A recusa do outro como busca de si mesmo. Exemplos saharianos, japoneses e franceses / La pérdida del apetito y el rechazo del otro como búsqueda de si mismo. Ejemplos saharianos, japoneses y franceses / Losing one's appetite. Rejection of the other as a quest for oneself. Examples from the Sahara, Japan and France / Perdre l'appétit. Le refus de l'autre comme quête de soi. Exemples sahariens, japonais et français

Esta reflexão antropológica baseia-se em pesquisas realizadas com jovens de 13 a 25 anos de idade, que permanecem isolados no seu quarto. Sua imobilidade, que não se justifica por nenhuma deficiência física ou psicológica, questiona o lugar do corpo no momento da passagem para a vida adulta. Estes jovens expressam uma ausência de apetite do outro, que vai de mãos dadas com a abstinência sexual forçada pelo seu isolamento. A hipótese é que eles experimentam uma relação com seu corpo, sua identidade sexual -e sua sexualidade -assim como com a alimentação, comparável às adolescentes que sofrem de anorexia nervosa, mas ao contrário. Estes comportamentos questionam as relações de gênero e a distribuição de papéis dentro da família. Com base em entrevistas e observações, tanto em casa como nos centros de cuidados, este artigo mostra que estes corpos adolescentes, tornados invisíveis por confinamento ou magreza extrema, são paradoxalmente uma expressão ostensiva de despossessão de si. Um novo apetite é possível quando surge o desejo de diferenciação e permite-se novos encontros

Esta reflexión antropológica se basa en una investigación realizada con jóvenes, de 13 a 25 añosde edad, que están enclaustrados en su habitación. Su inmovilidad, que no se justifica por ningúna discapacidad física o psicológica, cuestiona el lugar del cuerpo en el momento del paso a la edad adulta. Estos jóvenes manifiestan una ausencia de apetito por los demás que va unida a la abstinencia sexual a la que les obliga su aislamiento. La hipótesis es que experimentan una relación con su cuerpo, su identidad sexual -y su sexualidad-así como con la comida, comparable a la de las adolescentes que sufren anorexia nerviosa, pero a la inversa. Estos comportamientos cuestionan las relaciones de género y el reparto de roles en la familia. Basándose en entrevistas y observaciones, tanto en el hogar como en los centros de atención, este artículo muestra que estos cuerpos adolescentes, invisibilizados por el confinamiento o la extrema delgadez, son paradójicamente una ostentosa expresión del desposeimieto de si. Un nuevo apetito es posible cuando surge el deseo de diferenciación y se permite nuevos encuentros

This anthropological reflection is based on research carried out with young boys, aged 13 to 25, who are cloistered in their room. Their immobility, which cannot be explained by any kind of physical or psychological disability, raises questions about the body's place at the time they are passing into adulthood. These young people express an absence of appetite for others that goes hand in hand with the sexual abstinence that their withdrawal forces them to have. The hypothesis is that they experience a relationship with their body, their sexual identity -and their sexuality -as well as with food, comparable to young girls suffering from anorexia nervosa but in reverse. These behaviours question gender relations and the distribution of roles within the family. Based on interviews and observations, both at home and in care facilities, this article shows that these adolescent bodies, made invisible by confinement or extreme thinness, are paradoxically an ostentatious expression of self-dispossession. A new appetite is possible when the desire for differentiation emerges and allows new encounters

Cette réflexion anthropologique s'appuie sur une recherche menée auprès de jeunes garçons, de 13 à 25 ans, cloîtrés dans leur chambre. Leur immobilité, que ne justifie aucun handicap physique ou psychique, interroge la place du corps au moment du passage à l'âge adulte. Ces jeunes expriment une absence d'appétit de l'autre qui va de pair avec l'abstinence sexuelle que leur retrait oblige. L'hypothèse émiseest qu'ils vivent un rapport au corps, à leur identité sexuelle -et à leur sexualité-ainsi qu'à l'alimentation, comparable aux jeunes filles souffrant d'anorexie mentale mais de manière inversée. Ces conduites interrogent les rapports de genre et la distribution des rôles au sein de la famille. À partir d'entretiens et d'observations, à domicile et dans des structures de soin, cet article montre que ces corps adolescents invisibilisés par l'enfermement ou l'extrême maigreur sont paradoxalement une expression ostentatoire d'une dépossession de soi. Un appétit nouveau est possible lorsque le désir de différenciation émerge et permet de nouvelles rencontres

Recaída en el consumo de alcohol después del trasplante de hígado por hepatopatía alcohólica / Alcohol relapse after liver transplantation for alcoholic liver disease

Introducción. La enfermedad hepática inducida por uso de alcohol se ha considerado una enferme-dad autoinfligida que limitaba el acceso al trasplante. Actualmente es una de las principales indicacio-nes de trasplante hepático en Colombia y el mundo, con excelente sobrevida. Metodología. Estudio descriptivo observacional donde se realizó una caracterización de los pacientes con trasplante hepá-tico por hepatopatía alcohólica en una institución de cuarto nivel, que incluyó un estudio cualitativo de la recaída en el consumo de alcohol postrasplante. Resultados. De 87 pacientes de una cohorte inicial de 96 pacientes trasplantados entre 2003 y 2021, se describieron características sociodemo-gráficas, comorbilidades previas y adquiridas posterior al trasplante, supervivencia del paciente y del injerto, y factores de riesgo asociados al consumo de alcohol. Adicionalmente, a 65 pacientes se les pudo realizar una entrevista estructurada para evaluar la recaída en el consumo de alcohol, 41,53 % volvieron a consumir alcohol; 23,07 % en patrón de riesgo de recaída y 18,46 % en patrón de slip (desliz). El antecedente de hepatitis alcohólica tuvo un RR de 3,273 (1,464­7,314) y p=0,007 para recaída en el consumo de alcohol, y la comorbilidad psiquiátrica un RR de 2,395 (1,002­5,722) y p=0,047. Finalmente, haber presentado al menos una recaída postrasplante tuvo un RR de 5,556 (1,499­20,588) con p=0,005 para rechazo del injerto. Conclusiones. La recaída en el consumo de alcohol fue frecuente, la hepatitis alcohólica previa y la comorbilidad psiquiátrica son factores de riesgo asociados. La recaída se asoció a rechazo del injerto sin afectar la sobrevida del paciente.

Introduction. Alcohol-induced liver disease has been considered a self-inflicted disease that limited access to transplantation. It is currently one of the main indications for liver transplantation in Colom-bia and the world, with excellent survival. Methodology. Observational descriptive study where a characterization of liver transplant patients due to alcoholic liver disease was carried out in a fourth level institution, which included a qualitative study of relapse in post-transplant alcohol consumption. Results. Of 87 patients from an initial cohort of 96 transplant patients between 2003 and 2021, sociodemographic characteristics, previous and acquired post-transplant comorbidities, patient and graft survival, and risk factors associated with alcohol consumption were described. Additionally, 65 patients were able to undergo a structured interview to assess relapse in alcohol consumption, 41.53% returned to alcohol consumption; 23.07% in risk relapse pattern, and 18.46% in slip pattern. The history of alcoholic hepatitis had a RR of 3.273 (1.464-7.314) and a p=0.007 for relapse in alcohol consumption, and psychiatric comorbidity a RR of 2.395 (1.002-5.722) and a p=0.047. Finally, having presented at least one post-transplant relapse had a RR of 5.556 (1.499-20.588) with ap=0.005 for graft rejection. Conclusions. Relapse in alcohol consumption was fre-quent, previous alcoholic hepatitis and psychiatric comorbidity were associated risk factors. Relapse was associated with graft rejection without affecting patient survival.

A Case of Withdrawal Syndrome after Opioid Discontinuation Following Pain Relief of Bone Metastases

Introduction: In patients receiving opioids, relief of cancer pain by palliative radiation therapy or other means can lead to opioid discontinuation and subsequent withdrawal symptoms, such as agitation, insomnia, and diarrhea, due to opioid-related physical dependence. Appropriate steps should be taken to prevent these symptoms. Case: A 72-year-old man underwent surgery for esophageal cancer. He developed low back pain and right lower limb pain, and was diagnosed with sacral and right iliac bone metastases. His pain was resistant to oxycodone (OXC), so he was simultaneously treated with methadone (MDN) and palliative radiotherapy. His pain gradually decreased, and MDN was tapered and switched to OXC, which was in turn discontinued at 20 mg/day at the patient's strong request. After OXC discontinuation, akathisia, anxiety, and diarrhea appeared as withdrawal symptoms. These were treated with immediate-release OXC, transdermal fentanyl, and suvorexant. Discussion: When discontinuing opioids, dose reduction below 10% per week is recommended, de-escalation to the lowest possible dose should be followed by cessation. In case of withdrawal symptoms, immediate-release opioids may be used, and opioid tapering should be attempted in parallel with symptom control.

Estratégias para manejo e prevenção da síndrome de abstinência em pacientes pediátricos críticos: revisão sistemática / Strategies for the management and prevention of withdrawal syndrome in critically ill pediatric patients: a systematic review

RESUMO Objetivo: Verificar as estratégias de prevenção e tratamento da síndrome de abstinência em unidade de terapia intensiva pediátrica. Métodos: Trata-se de revisão sistemática nas bases de dados PubMed®, Lilacs, Embase, Web of Science, Cochrane, Cinahl, Cochrane Database Systematic Review e CENTRAL. Uma estratégia de busca em três etapas foi utilizada para esta revisão. O protocolo da revisão foi aprovado no PROSPERO (CRD42021274670). Resultados: Foram incluídos na análise 12 artigos. Observou-se grande heterogeneidade entre os estudos incluídos, principalmente em se tratando de esquemas terapêuticos utilizados na sedação e na analgesia. As doses de midazolam variaram de 0,05mg/kg/hora a 0,3mg/kg/hora. A morfina também variou consideravelmente, de 10mcg/kg/hora a 30mcg/kg/hora entre os estudos. A escala mais utilizada para identificação da síndrome de abstinência, entre os 12 estudos selecionados, foi a Sophia Observational Widrawal Symptoms Scale. Em três estudos, houve diferença estatística relevante na prevenção e no manejo da síndrome de abstinência com a implantação de protocolos (p < 0,01 e p < 0,001). Conclusão: Observou-se grande variação entre o regime de sedoanalgesia utilizado entre os estudos e o método de desmame e avaliação de síndrome de abstinência. São necessários mais estudos para fornecer evidências mais robustas acerca do tratamento mais indicado para prevenção e redução dos sinais e sintomas de abstinência em crianças criticamente doentes. Registro PROSPERO:CRD 42021274670

ABSTRACT Objective: To verify strategies for the prevention and treatment of abstinence syndrome in a pediatric intensive care unit. Methods: This is a systematic review in the PubMed database®, Lilacs, Embase, Web of Science, Cochrane, Cinahl, Cochrane Database Systematic Review and CENTRAL. A three-step search strategy was used for this review, and the protocol was approved in PROSPERO (CRD42021274670). Results: Twelve articles were included in the analysis. There was great heterogeneity among the studies included, especially regarding the therapeutic regimens used for sedation and analgesia. Midazolam doses ranged from 0.05mg/kg/hour to 0.3mg/kg/hour. Morphine also varied considerably, from 10mcg/kg/hour to 30mcg/kg/hour, between studies. Among the 12 selected studies, the most commonly used scale for the identification of withdrawal symptoms was the Sophia Observational Withdrawal Symptoms Scale. In three studies, there was a statistically significant difference in the prevention and management of the withdrawal syndrome due to the implementation of different protocols (p < 0.01 and p < 0.001). Conclusion: There was great variation in the sedoanalgesia regimen used by the studies and the method of weaning and evaluation of withdrawal syndrome. More studies are needed to provide more robust evidence about the most appropriate treatment for the prevention and reduction of withdrawal signs and symptoms in critically ill children. PROSPERO register: CRD 42021274670

Repercussões da pandemia da Covid-19 em crianças do Ensino Fundamental / Repercussions of the COVID-19 pandemic on Elementary School children

RESUMO A saúde mental infantil no contexto da pandemia precisa ser observada com atenção devido a maior vulnerabilidade emocional dessa população. Objetivou-se conhecer as questões emocionais e comportamentais vivenciadas pelas crianças durante o período da pandemia da Covid-19, conforme a percepção dos pais. Buscou-se identificar as necessidades emocionais e psicológicas das crianças em idade escolar, matriculadas no Ensino Fundamental I, com idades entre seis e dez anos, de duas escolas privadas de um município do Vale do Caí/RS. Estudo qualitativo, cujas entrevistas foram realizadas por meio da plataforma Google Meet. Os dados foram gravados e transcritos, submetidos à análise de conteúdo qualitativa de Bardin, com auxílio do QRS NVivo. Os resultados foram organizados em duas categorias: percepção dos pais acerca das necessidades emocionais infantis; e aspectos promotores da saúde mental para as crianças durante o período de distanciamento social da pandemia da Covid-19. As crianças estiveram sujeitas a desenvolver ansiedade, entre outros comportamentos acionados pelo distanciamento social, tais como tristeza, agressividade e medo. Porém, estratégias de promoção da saúde, brincadeiras, passeios ao ar livre, em áreas verdes aos quais as famílias tinham acesso, e o diálogo adotado por parte dos pais colaboraram para a promoção da saúde mental das crianças.

ABSTRACT Children's mental health in the context of the pandemic needs to be carefully observed due to the emotional vulnerability of this population. This study aimed to know the emotional and behavioral issues experienced by children during the period of the COVID-19 pandemic, as perceived by their parents. We sought to identify the emotional and psychological needs of school-age children, enrolled in elementary school I, aged 6 to 10 years, from two private schools in a city in Vale do Caí/RS. This is a qualitative study, whose interviews were conducted through the Google Meet platform. The data were recorded and transcribed, submitted to Bardin's qualitative content analysis, with the aid of QRS NVivo. The results were organized into two categories: Perception of parents about children's emotional needs; and aspects promoting of mental health for children during the period of social distancing in the COVID-19 pandemic. Children were prone to developing anxiety, among other behaviors triggered by social withdrawal, such as sadness, aggression, and fear. However, health promotion strategies, playing, outdoor strolls in green areas to which families had access, and the dialogue adopted by the parents collaborated to promote the children's mental health.

Clinical perspectives on the management of common psychiatric disorders in India

Psychiatric disorders are common health problems in patients of all age groups, under-diagnosis and under-treatment of these disorders can result in disability and serious complications. With an objective of creating a comprehensive evidence-based consensus on common mental health disorders and their management in the Indian setting, 10 expert groups meetings involving 98 psychiatrists across India were conducted in the month of May 2020. Clinical insights related to burden, signs and symptoms, diagnosis and management were summarized based on the discussions during these meetings. Experts agreed that depressive disorders and anxiety disorders represent two important psychiatric disorders in India. Selective serotonin reuptake inhibitors (SSRIs) are commonlyused for the treatment of depression. Benzodiazepines are effective for the treatment of comorbid anxiety in patients with depression, but their long-term use causes adverse events such as dependence and withdrawal reaction. Obsessive compulsive disorder (OCD), bipolar disorder, substance use especially alcohol withdrawal syndrome, and sleep disorders are other common psychiatric disorders found among Indian patients. Lithium and valproate represent the commonly used and effective pharmacological treatments for bipolar disorder. SSRIs are preferred drugs in the treatment of OCD,whereas benzodiazepines such as chlordiazepoxide and diazepam represent important pharmacological treatment optionsfor alcohol withdrawal. Early identification and timely and effective treatment of psychiatric disorders is important for prevention of complications. Treatment should be individualized based on efficacy, tolerability profile of the medicine, risk of drug interactions, and cost. This consensus may be useful to psychiatrists and general practitioners treating common psychiatric conditions in Indian patients.

Impacto del abandono de la lactancia materna exclusiva sobre la salud de los lactantes / Impact of exclusive breastfeeding withdrawal on the health of babies

Introducción: El abandono de la lactancia materna es uno de los problemas que enfrenta el Sistema Nacional de Salud en Cuba por las consecuencias desfavorables que representa para la salud de los lactantes. Objetivo: Identificar la relación entre el abandono de la lactancia materna exclusiva y las afectaciones en la salud de los lactantes. Material y Métodos: Se realizó un estudio descriptivo, retrospectivo de corte transversal, en 105 lactantes del Policlínico Aleida Fernández Chardiet nacidos en 2019, cuyas madres dejaron de utilizar la lactancia materna exclusiva antes del sexto mes. Las variables utilizadas fueron edad materna, tiempo de duración de la lactancia materna exclusiva, las enfermedades más frecuentes diagnosticadas en el niño y la necesidad de ingresos hospitalarios. Se aplicó la prueba no paramétrica de independencia Chi Cuadrado para demostrar la relación entre variables. Resultados: Predominó el abandono de la lactancia materna exclusiva antes de los 3 meses y no se encontró relación estadísticamente significativa entre esta y las afecciones más frecuentes de los lactantes (las IRA en 40 por ciento y las EDA en 23,8 por ciento). El 55,2 por ciento necesitó ingreso hospitalario antes del sexto mes y la relación con el abandono precoz de la lactancia materna exclusiva fue estadísticamente significativa. Conclusiones: El abandono precoz de la lactancia materna exclusiva afecta la salud de los lactantes y aunque las afecciones no tuvieron una relación estadísticamente significativa con aquella sí tienen una elevada frecuencia en estos niños de tan corta edad(AU)

Introduction: Breastfeeding withdrawal is one of the challenges faced by the Cuban National Health System due to its adverse consequences on the health of babies. Objective: To identify the relationship between exclusive breastfeeding withdrawal and health disorders in babies. Material and Methods: A descriptive, retrospective, cross-sectional study was carried out on 105 breastfed babies from "Aleida Fernández Chardiet" Policlinic who were born in 2019 and were precociously weaned from exclusive breastfeeding before the sixth month. The variables used were: maternal age, duration of exclusive breastfeeding, most frequent diseases diagnosed in the child, and need for hospital admission. The chi-squared non-parametric independence test was used to show the relationship among variables. Results: Exclusive breastfeeding withdrawal before the third month was predominant (71, 4 percent); the most frequent diseases diagnosed were respiratory diseases and diarrheas (40 percent and 23,8 percent, respectively); about half the babies required hospital admission (55,2 percent) before the sixth month; the relationship with early withdrawal of breastfeeding was statistically significant. Conclusions: Early withdrawal of breastfeeding has negative effects on the health of babies. Although the illnesses did not have a statistically significant relationship with it, a high frequency of their incidence was found in such young babies(AU)

Reflexiones acerca de algunos de los efectos de la pandemia en la clínica con niños y adolescentes / Reflections on some of the effects of the pandemic in the clinic with children and adolescents / Réflexions sur certains effets de la pandémie dans la clinique avec les enfants et les adolescents / Reflexões sobre alguns dos efeitos da pandemia na clínica com crianças e adolescentes

El presente artículo plantea reflexiones respecto de algunas consecuencias en la clínica con niños/as y adolescentes debidos al impacto de la pandemia por Covid19. Se señala la acción de la incertidumbre y lo imprevisible sobre la subjetividad de la población y se propone recordar los acontecimientos ligados a las medidas de protección (Aislamiento Social Preventivo y Obligatorio, de dos años de duración) y resignificarlos para aventurar una incipiente historización sobre algunos de los efectos que la pandemia produjo sobre la labor clínica con niños/as y adolescentes. A tal fin, se toma como eje conceptual rector el desarrollo freudiano sobre la retracción libidinal y sus consecuencias para el Yo, y los cambios en los recursos técnicos que debieron implementarse al incluirse las sesiones on-line. Se puntualizan las consecuencias perturbadoras de la pandemia respecto de los niños pequeños, con patologías graves y en los adolescentes tomando en cuenta la especificidad de sus características subjetivas AU

The following paper presents reflections on certain consequences on the clinic with children and teenagers due to the impact of the Covid-19 pandemic. The action of uncertainty and the unpredictable on the subjectivity of the population is pointedout and it is proposed to recall the events linked to protection measures (Mandatory Preventive Isolation, lasting two years) and resignify them to venture an incipient historicization about some of the effects that the pandemic produced on clinical work with children and adolescents.For this purpose, the Freudian development on libidinal withdrawal and its consequences for the Self, and the changes in the technical resources that had to be implemented when online sessions were installed, are taken as theguiding conceptual axis. The disturbing consequences of the pandemic are pointed out regarding young children, those with serious pathologies and in adolescents, taking into account the specificity of their subjective characteristics AU

Cet article propose des réflexions concernant certaines conséquences en clinique auprès des enfants et des adolescents dû à l'impact de la pandémie de Covid19. Les conséquences de l'incertitude et de l'imprévisible sur la subjectivité de la population sont dénotées et il est proposé de rappeler les événements liés aux mesures de protection (Isolement Préventif Obligatoire, d'une durée de deux ans) et de les resignifier pour s'aventurer à un début d'historisation de certains des effets que la pandémie a eu sur le travail clinique avec les enfants et les adolescents. Pour cela, le développement freudien sur le retrait libidinal et ses conséquences sur le Moi, et les évolutions des moyens techniques qu'il a fallu mettre en œuvre lors de l'implémentation des séances en ligne, sont pris comme axe conceptuel directeur.Les conséquences inquiétantes de la pandémie sont dénotées concernant les jeunes enfants, atteints de pathologies graves, et les adolescents, tout en prenant en compte la spécificité de leurs caractéristiques subjectives AU

Este artigo traz reflexões sobre algumas consequências na clínica com crianças e adolescentes devido ao impacto da pandemia de Covid19. Aponta-se a ação da incerteza e do imprevisível sobre a subjetividade da população e propõe-se relembrar os eventos vinculados às medidas de proteção (Isolamento Preventivo Obrigatório, com duração de dois anos) e ressignifica esses para arriscar uma incipiente historicização sobre alguns dos efeitos que a pandemia produziu no trabalho clínico com crianças e adolescentes. Para tanto, toma-se como eixo conceitual constitutivo o desenvolvimento freudiano sobre a retirada libidinal e suas consequências para o Ego, e as mudanças nos recursos técnicos que tiveram que ser implementados quando da inclusão das sessões online. As consequências perturbadoras da pandemia são apontadas em relação às crianças pequenas, aos portadores de patologias graves e aos adolescentes, tendo em conta a especificidade das suas características subjetivas AU

Recién nacidos hijos de madres adictas. Formas de presentación: no todo se trata de síndrome de abstinencia

RESUMEN El consumo de drogas ilegales por la mujer gestante puede ocasionar morbilidades potencialmente graves en el feto y recién nacido. Las manifestaciones en el niño pueden ser diversas, por lo que es necesario un alto índice de sospecha a fin de realizar el diagnóstico y tratamiento apropiados. Se presentan tres casos de recién nacidos, hijos de madres adictas, con variadas expresiones clínicas.

ABSTRACT Illegal drug consumption by pregnant women can cause potentially serious morbidities in the fetus and newborn. Manifestations in children can be diverse, so a high index of suspicion is necessary in order to appropriately diagnose and treat this condition. Three cases of newborns, born to mothers with substance-abuse disorder, with various clinical presentations are reviewed.

Delirium, catatonía y síndrome de abstinencia manifestados como agitación psicomotora en COVID-19: una propuesta de manejo farmacológico en el hospital general

Background: Neuropsychiatric symptoms can be part of the clinical spectrum of COVID-19 infections. Aim: To devise an evidence based clinical algorithm as a guide for clinicians, to identify and treat underlying clinical syndromes of psychomotor agitation, such as delirium, catatonia or substance withdrawal in patients who are hospitalized and infected with SARS-CoV-2. Material and Methods: A review of the literature about the pharmacological management of neuropsychiatric manifestations of COVID-19 at the general hospital, to develop a clinical protocol based on a consensus from an interdisciplinary expert panel at a Clinical Hospital. Results: A consensual clinical algorithm for the management of delirium, catatonia, and substance withdrawal, manifested as psychomotor agitation in patients hospitalized with COVID-19, was developed as a clinical proposal for physicians at different levels of complexity in health services. Conclusions: Cooperation among different clinical units in the general hospital facilitated the implementation of a clinical algorithm for clinicians for the management of psychomotor agitation in COVID-19 patients.

Study of clinical and etiological profile of new onset seizure in adults reporting to tertiary care centre, Mysore

Background: Overall incidenceof seizure is found to be 0.2-0.6 per 1000 population per year. A first seizure mandates individual counselling about the risk of recurrence, the pros and cons of drug treatment. Seizures are usually a manifestation of an underlying pathology which may be genetic, structural or metabolic.Objectives of current study wereto study the clinical profile of new onset seizures in adults (greater than 19 years) attending to tertiary care Centre, Mysore and to determine the etiology of new onset seizures in adults reporting to tertiary care centre, Mysore.Methods:All participants fulfilling the inclusion criteria were interviewed as per proforma. Participant抯 demographic, social and medical details were recorded in proforma sheet and patients were subjected to neuroimaging studies, EEG and other necessary blood investigations. In all cases the seizure type is classified according to ILAE Classification 2017.Results:Among 100 cases evaluated for new onset, Majority of the patients were 41 to 60 years. Generalised seizures (95%) were more common than focal seizures.Among neurological etiological causes, vascular causes (34%) were most common. Most common Non-neurological cause for seizures was alcohol withdrawal (46.67%).Conclusions: If proper analysis of etiologyis made, seizures can be treated accordingly thus reducing the morbidity and mortality associated with it. Primary care physicians play a pivotal role in identifying patients with adult onset seizures and should encourage these patients to undergo neuroimaging so as to arrive at an appropriate etiological diagnosis.