ABSTRACT
ABSTRACT Introduction Enuresis, defined as an intermittent urinary incontinence that occurs during sleep, is a frequent condition, occurring in about 10% of children at 7 years of age. However, it is frequently neglected by the family and by the primary care provider, leaving many of those children without treatment. Despite of many studies in Enuresis and recent advances in scientific and technological knowledge there is still considerable heterogeneity in evaluation methods and therapeutic approaches. Materials and Methods The board of Pediatric Urology of the Brazilian Society of Urology joined a group of experts and reviewed all important issues on Enuresis and elaborated a draft of the document. On September 2018 the panel met to review, discuss and write a consensus document. Results and Discussion Enuresis is a multifactorial disease that can lead to a diversity of problems for the child and family. Children presenting with Enuresis require careful evaluation and treatment to avoid future psychological and behavioral problems. The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies.
Subject(s)
Humans , Child , Practice Guidelines as Topic/standards , Consensus , Enuresis/diagnosis , Enuresis/therapy , Behavior Therapy/methods , Algorithms , Cholinergic Antagonists/therapeutic use , Deamino Arginine Vasopressin/therapeutic use , Enuresis/classification , Antidiuretic Agents/therapeutic use , Antidepressive Agents, Tricyclic/therapeutic useSubject(s)
Humans , Primary Health Care , Practice Guidelines as Topic , Constipation/therapy , Irritable Bowel Syndrome/therapy , Diarrhea/therapy , Parasympatholytics/therapeutic use , Peptides/therapeutic use , Selective Serotonin Reuptake Inhibitors/therapeutic use , Constipation/etiology , Irritable Bowel Syndrome/complications , Diarrhea/etiology , Diet Therapy/methods , Laxatives/therapeutic use , Loperamide/therapeutic use , Antidepressive Agents, Tricyclic/therapeutic use , Antidiarrheals/therapeutic useABSTRACT
RESUMEN Las reacciones adversas a los medicamentos, son una reacción nociva o no intencionada. Ocurre con las dosis habituales empleadas en el ser humano para la profilaxis, diagnóstico o tratamiento de enfermedades y también para modificar las funciones fisiológicas. Con esta revisión se pretendió proporcionar una actualización de las reacciones de los fármacos antidepresivos. Se tuvo en cuenta cuestiones importantes, tales como: la selección, forma de uso, duración de la terapia y consideraciones relacionadas con situaciones patológicas particulares (AU).
ABSTRACT Adverse reactions to drugs are a noxious and non-intended reaction. It occurs with the doses usually used for prophylaxis, diagnosis and disease treatment in the human being, and also for modifying the physiologic functions. The aim of this review was giving an update of the reactions to anti-depressant drugs. Important questions were taken into account like drug choose, form of use, therapy lasting and considerations related to particular pathologic situations (AU).
Subject(s)
Humans , Depression/epidemiology , Drug-Related Side Effects and Adverse Reactions/epidemiology , Antidepressive Agents/adverse effects , Antidepressive Agents/therapeutic use , Bibliography of Medicine , Antidepressive Agents, Second-Generation/adverse effects , Antidepressive Agents, Tricyclic/therapeutic use , Antidepressive Agents, Tricyclic/pharmacologyABSTRACT
Abstract: Few studies have described therapeutic options in brachioradial pruritus. We describe a cross-sectional study of brachioradial pruritus patients treated in an outpatient unit. We reviewed medical records and interviewed brachioradial pruritus patients without indication for decompressive surgery, in order to access the perceptions of intensity of pruritus prior to treatment and response to therapy. We found that antidepressants and anticonvulsants were the most frequently prescribed drugs. Best reductions in pruritus were associated with its highest intensities prior to treatment, and with longer periods of therapy.
Subject(s)
Humans , Male , Female , Middle Aged , Pruritus/drug therapy , Cyclohexanecarboxylic Acids/therapeutic use , Doxepin/therapeutic use , Amines/therapeutic use , Amitriptyline/therapeutic use , Antidepressive Agents, Tricyclic/therapeutic use , Antipsychotic Agents/therapeutic use , Cross-Sectional Studies , Drug Therapy, Combination , Antidepressive Agents, Tricyclic/classificationABSTRACT
Transtornos depressivos são condições que apresentam curso crônico e recorrente. Estima-se uma prevalência de cerca de 6% em um ano e cerca de 16% durante a vida, sendo duas a três vezes mais frequente em mulheres do que em homens. Em amostras clínicas, dados epidemiológicos indicam prevalências ainda maiores: ao redor de 10% na atenção primária e entre 20% e 30% entre pacientes internados por qualquer doença. O transtorno se caracteriza por ter determinação multifatorial: predisposição genética, ambiente estressor e características de personalidade e temperamento. Esta guia apresenta informação que orienta a conduta para casos de depressão no contexto da Atenção Primária à Saúde, incluindo: Diagnóstico, Critérios DSM-5, Tratamento aspectos gerais, Tratamento conforme gravidade, Posologia comuns dos antidepressivos, Tratamento na ausência de resposta, Duração do tratamento, Encaminhamento para serviço especializado.
Subject(s)
Humans , Depression/diagnosis , Depression/therapy , Primary Health Care , Psychotherapy/methods , Referral and Consultation , Antidepressive Agents, Tricyclic/therapeutic useABSTRACT
Summary In clinical practice, hospital admission of patients with altered level of consciousness, sleepy or in a non-responsive state is extremely common. This clinical condition requires an effective investigation and early treatment. Performing a focused and objective evaluation is critical, with quality history taking and physical examination capable to locate the lesion and define conducts. Imaging and laboratory exams have played an increasingly important role in supporting clinical research. In this review, the main types of changes in consciousness are discussed as well as the essential points that should be evaluated in the clinical management of these patients.
Resumo Abordagem Na prática clínica é extremamente comum a admissão hospitalar de pacientes com nível de consciência alterado, sonolentos ou em estado não responsivo. Essa condição clínica demanda uma investigação eficaz e um tratamento precoce. É fundamental a realização de uma avaliação focada e objetiva, com a realização de anamnese e exame físico de qualidade para localizar a lesão e definir condutas. Exames de imagem e laboratoriais têm desempenhado papéis cada vez mais relevantes no suporte à investigação clínica. Nesta revisão, são discutidos os principais tipos de alterações de consciência e os pontos imprescindíveis que devem ser avaliados na abordagem clínica desses pacientes.
Subject(s)
Humans , Consciousness Disorders/diagnosis , Physical Examination , Prognosis , Algorithms , Consciousness , Consciousness Disorders/classification , Consciousness Disorders/drug therapy , Diagnosis, Differential , Anticonvulsants/therapeutic use , Antidepressive Agents, Tricyclic/therapeutic useABSTRACT
El síndrome de dolor vesical (SDV) es un cuadro que forma parte del dolor pelviano crónico (DPC), donde el origen del dolor esta en mecanismos de neuromodulación. En este sentido, los antidepresivos tricíclicos (ATC), especialmente amitriptilina, son la terapia de primera línea. Sin embargo, los efectos adversos dificultan la adherencia a la terapia. Imipramina, otro ATC, presenta menores efectos adversos, aunque su eficacia no ha sido evaluada en SDV. Objetivo: Evaluar la eficacia de imipramina en el tratamiento de SDV en un estudio piloto. Metodología: Veinte pacientes con diagnóstico de SDV, fueron tratadas con imipramina 25 mg cada 8 horas vía oral durante 30 días. Se evaluó intensidad de dolor según EVA antes y al término del tratamiento. Además se evaluó sintomatología urinaria utilizando el cuestionario PUF. Resultados: Diecinueve pacientes completaron el tratamiento. Una paciente abandonó el tratamiento por síntomas gastrointestinales. Ocho de 19 pacientes mostraron una mejoría total del dolor al término del tratamiento. Tres pacientes más lograron una respuesta completa con 3 meses de tratamiento con imipramina. La intensidad del dolor según EVA y la puntuación en el cuestionario PUF mejoraron significativamente al término del tratamiento. Efectos secundarios a imipramina fueron referidos por 4 de 19 pacientes, y fueron menores. Conclusión: Imipramina mostró ser una terapia efectiva en el manejo de SDV, con efectos adversos menores. Se requieren estudios comparativos con mayor número de pacientes para considerar su utilidad clínica en el manejo del SDV...
Bladder pain syndrome (BPS) is a symptom which is part of chronic pelvic pain (CPP), where the origin of the pain is in the neuromodulation mechanisms. In this context, tricyclic antidepressants (TCAs), especially amitriptyline, are a first line therapy. However, adverse effects make continuing with the therapy difficult. Imipramine, another TCA, has lesser adverse effects, although its effectiveness has not been evaluated in BPS. Objective: Evaluate the effectiveness of imipramine in the treatment of BPS in a pilot study. Methodology: Twenty patients with a diagnosis of BPS were treated taking 25 mg of imipramine orally every 8 hours, for 30 days. The intensity of the pain following PIS was evaluated before and after the treatment. In addition, the urinary symptomatology was evaluated using the PUF questionnaire. Results: Nineteen patients completed the treatment. One patient abandoned the treatment due to gastrointestinal symptoms. Eight of the 19 patients had completely recovered at the end of the treatment. Three other patients achieved a complete recovery after 3 months of treatment with imipramine. The intensity of the pain following the PIS, and the score on the PUF questionnaire, significantly improved by the end of the treatment. Secondary effects to imipramine were referred by 4 of the 19 patients, and these were minor. Conclusion: Imipramine was shown to be an effective therapy for dealing with BPS, with minor adverse effects. Comparative studies are required with a higher number of patients to consider its clinical use in the handling of BPS...
Subject(s)
Humans , Female , Adult , Middle Aged , Antidepressive Agents, Tricyclic/therapeutic use , Pelvic Pain/drug therapy , Urinary Bladder Diseases/drug therapy , Imipramine/therapeutic use , Cystitis, Interstitial , Pain Measurement , Pelvic Pain/etiology , Urinary Bladder Diseases/complications , Prospective Studies , Pilot ProjectsABSTRACT
No abstract available.
Subject(s)
Female , Humans , Male , Amitriptyline/therapeutic use , Antidepressive Agents, Tricyclic/therapeutic use , Citalopram/therapeutic use , Dyspepsia/drug therapy , Quality of Life , Selective Serotonin Reuptake Inhibitors/therapeutic useABSTRACT
A fibromialgia (FM) é uma síndrome de dor difusa crônica acompanhada de sintomas somáticos, tais como fadiga, transtornos do humor, do sono e da cognição. Em uma abordagem prática do paciente com FM, além das medidas não farmacológicas, cada sintoma pode ser tratado com medicamento específico. O objetivo deste artigo é prover revisão atualizada da literatura sobre os principais medicamentos atualmente disponíveis no Brasil para o tratamento da FM em adultos. O sucesso terapêutico da FM depende, essencialmente, do uso racional de medicamentos voltados para os sintomas refratários às medidas não farmacológicas.
Fibromyalgia (FM) is the chronic widespread pain syndrome associated with fatigue, mood, sleep and cognitive disorders. Besides non-pharmacological approach, each symptom should be treated with a specific drug. The goal of this study is to provide up-to-date literature review on main aspects of adult FM drugs available for use in Brazil. Treatment success in FM depends essentially on using drugs based on symptoms that are not responsive to non-pharmacological approach.
Subject(s)
Humans , Fibromyalgia/drug therapy , Tramadol/therapeutic use , Serotonin/therapeutic use , Selective Serotonin Reuptake Inhibitors/therapeutic use , Acetaminophen/therapeutic use , Monoamine Oxidase Inhibitors/therapeutic use , Antidepressive Agents, Tricyclic/therapeutic useABSTRACT
Objective To evaluate the use of a therapeutic regimen to treat attention deficit hyperactivity disorder patients. Methods A total of 140 patients initially underwent physical, neurological and laboratory evaluation. Thereafter, treatment was initiated with a compounding product consisting of a tricyclic antidepressant and an anxiolytic. Results The response was positive in 71.43% of patients in controlling hyperactivity and improving dispersion and attention deficit. Conclusion The therapeutic regimen utilized proved to be an effective therapeutic alternative, especially for patients who do not adapt to psychostimulant drugs. .
Objetivo Avaliar a aplicação de um esquema terapêutico para o tratamento do transtorno do déficit de atenção e hiperatividade. Métodos Os 140 pacientes foram submetidos inicialmente à avaliação clínico-neurológica e laboratorial. Posteriormente, foi iniciado um tratamento com medicamento formulado composto por um antidepressivo tricíclico e um ansiolítico. Resultados A resposta foi positiva em 71,43% dos pacientes no controle da hiperatividade e na melhoria do quadro de dispersão e desatenção. Conclusão O esquema terapêutico aplicado se mostrou uma alternativa terapêutica eficaz, especialmente para os pacientes que não se adaptam aos medicamentos psicoestimulantes. .
Subject(s)
Child , Humans , Anti-Anxiety Agents/therapeutic use , Antidepressive Agents, Tricyclic/therapeutic use , Attention Deficit Disorder with Hyperactivity/drug therapy , Chlordiazepoxide/therapeutic use , Imipramine/therapeutic use , Drug Therapy, Combination/methods , Retrospective Studies , Treatment OutcomeABSTRACT
Se presenta un caso de una paciente femenina de 67 años de edad con antecedentes de hipertensión arterial y trastorno depresivo recurrente grave, a quien se le realizó histerectomía total con doble anexectomía. Se describe el tratamiento habitual para la enfermedad de base, el método anestésico empleado, el monitoreo intraoperatorio, las complicaciones presentadas e interacciones medicamentosas. En conclusión, el uso de antidepresivos tricíclicos continúan teniendo mala repercusión en interacción con fármacos anestésicos, pero es importante la valoración riesgo-beneficio de su empleo en dichos pacientes.
A case is presented of a female 67-year-old patient with a history of hypertension and severe recurrent depressive disorder who had undergone total hysterectomy with double adnexectomy. A description is provided of the usual treatment for the underlying disease, the anaesthetic procedure, intraoperative monitoring, emerging complications and drug interactions. It is concluded that tricyclic antidepressants cause harmful effects when they interact with anaesthetic drugs. Hence the importance of performing a risk-benefit analysis before using them with those patients.
Subject(s)
Humans , Female , Aged , Risk Assessment/methods , Depressive Disorder/therapy , Hypertension/diagnosis , Hysterectomy, Vaginal/statistics & numerical data , Anesthesia/adverse effects , Antidepressive Agents, Tricyclic/therapeutic useABSTRACT
We report a 43 years old HIV-1 infected male who developed a severe subacute neurological damage because of a progressive multifocal leukoencephalopathy confirmed by PCR for JC virus. The patient was treated with antiretroviral therapy in adequate doses for CNS penetration and mirtazapine, an antidepressant inhibitor of serotonin receptors. His evolution during one year follow up has been favorable in both, clinically and images.
Se presenta el caso clínico de un paciente de sexo masculino, de 43 años portador de VIH que desarrolló un grave daño neurológico subagudo debido a una leucoencefalopatía multifocal progresiva diagnosticada mediante reacción de polimerasa en cadena de virus JC. El paciente fue tratado con terapia anti-retroviral de penetración eficiente al SNC y con mirtazapina, un antidepresivo inhibidor de los receptores de serotonina. Su evolución durante un año de seguimiento ha sido favorable tanto del punto de vista clínico como de imágenes.
Subject(s)
Adult , Humans , Male , AIDS Dementia Complex/drug therapy , Antiretroviral Therapy, Highly Active , Antidepressive Agents, Tricyclic/therapeutic use , Leukoencephalopathy, Progressive Multifocal/drug therapy , Mianserin/analogs & derivatives , Drug Therapy, Combination/methods , Mianserin/therapeutic use , Treatment OutcomeABSTRACT
OBJECTIVE: The purpose of this study was to evaluate the efficacy and effectiveness of imipramine on the treatment of comorbid chronic dizziness and panic disorder. METHOD: Nine patients with panic disorder and agoraphobia associated with chronic dizziness underwent otoneurological screening and were treated with a 3-months course of imipramine. Anxiety levels were measured with the Hamilton Anxiety Scale (HAM-A), dizziness levels were evaluated using the Dizziness Handicap Inventory (DHI), and panic severity and treatment outcome were assessed with the Clinical Global Impression Scale (CGI). RESULTS: At the baseline 33.3 percent (n=3) had a bilateral peripheral deficit vestibulopathy, the mean scores for HAM-A were 27.2±10.4, for DHI were 51.7±22.7, and for CGI-S were 4.8±0.9. All patients had a significant reduction in their HAM-A (11.1±5.5, p=0.008), DHI (11.5±8.1, p=0.008) and CGI-I (1.8±0.7, p=0.011) levels after 3-months imipramine treatment (mean=72.2±23.2 mg/day). CONCLUSION: This study found a decrease in anxiety levels and in the impact of dizziness in the patients' quality of life after a 3-months treatment course with imipramine.
OBJETIVO: O objetivo deste estudo foi avaliar a eficácia e efetividade da imipramina no tratamento da tontura crônica e do transtorno de pânico comórbidos. MÉTODO: Nove pacientes com transtorno do pânico e agorafobia associada com tontura crônica foram submetidos à avaliação otoneurológica e tratados durante 3 meses com imipramina. Os níveis de ansiedade foram medidos através da Escala Hamilton de Ansiedade (HAM-A); os de tontura foram avaliados usando o Dizziness Handicap Inventory (DHI), e a gravidade do pânico e sua resposta pela Escala de Impressão Clínica Global (CGI). RESULTADOS: Na avaliação inicial, 33,3 por cento (n=3) da amostra apresentavam vestibulopatia periférica deficitária bilateral; as médias foram: da HAM-A 27,2±10,4, do DHI 51,7±22,7 e do CGI-S 4,8±0,9. Todos tiveram uma redução significativa nos escores de HAM-A (11,1±5,5, p=0,008), DHI (11,5±8,1, p=0,008) e CGI-I (1,8±0,7, p=0,011), após 3 meses de tratamento com imipramina (média=72,2±23,2 mg/dia). CONCLUSÃO: Este estudo encontrou uma diminuição dos níveis de ansiedade e do impacto da tontura na qualidade de vida dos pacientes após um curso de 3 meses de tratamento com imipramina.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Antidepressive Agents, Tricyclic/therapeutic use , Dizziness/drug therapy , Imipramine/therapeutic use , Panic Disorder/drug therapy , Agoraphobia/drug therapy , Agoraphobia/psychology , Chronic Disease , Dizziness/complications , Prospective Studies , Psychiatric Status Rating Scales , Panic Disorder/complications , Treatment OutcomeABSTRACT
In the present paper, we investigated the 5HTTLPR and STin2 polymorphisms in the promoter region of the serotonin transporter gene (SLC6A4), the G861C polymorphism (rs6296) of the serotonin receptor 1D beta (HTR1B), the T102C (rs6113) and C516T (rs6305) polymorphisms of the serotonin receptor gene subtype 2A (HTR2A), the DAT UTR, DAT intron 8 and DAT intron 14 of the dopamine transporter gene (SLC6A3), the Val-158-Met (rs4680) polymorphism of the COMT and the silent mutation G1287A (rs5569) in the norepinephrine transporter gene (SLC6A2). We genotyped 41 obsessive-compulsive disorder (OCD) outpatients, classified as good-responders (n=27) and poor-responders (n=14) to treatment with clomipramine according to the Yale Brown Obsessive-Compulsive Scale (YBOCS). Patients who achieved a reduction in symptoms of 40 percent or more in YBOCS after 14 weeks of treatment were considered good-responders. Genotypes and alleles distribution of the investigated polymorphisms were compared between both groups. We did not find association between the studied polymorphisms and clomipramine response in our sample.
No presente estudo, investigaram-se os polimorfismos 5HTTLPR e STin2 da região promotora do gene transportador de serotonina (SLC6A4), o G861C (rs6296) do receptor de serotonina 1D beta (HTR1B), os polimorfismos T102C (rs6113) e C516T (rs6305) do gene do receptor da serotonina subtipo 2A (HTR2A), os polimorfismos UTR, intron 8 e intron 14 do gene transportador de dopamina (SLC6A3), o Val-158-Met (rs4680) da COMT e a mutação G1287A (rs5569) do gene do transportador de norepinefrina (SLC6A2). Foram genotipados 41 pacientes com transtorno obsessivo-compulsivo (TOC), classificados como bons-respondedores (n=27) e maus-respondedores (n=14) ao tratamento com clomipramina, por meio do uso da Escala de Sintomas Obsessivos-Compulsivos Yale Brown (YBOCS). Foram considerados bons-respondedores os pacientes que tiveram redução nos sintomas em 40 por cento ou mais na YBOCS, após 14 semanas de tratamento. A distribuição dos genótipos e alelos estudados foi comparada entre os dois grupos. Não foi encontrada associação entre estes polimorfismos investigados e a resposta à clomipramina na amostra estudada.
Subject(s)
Adult , Female , Humans , Male , Young Adult , Antidepressive Agents, Tricyclic/therapeutic use , Clomipramine/therapeutic use , Dopamine Plasma Membrane Transport Proteins/genetics , Norepinephrine Plasma Membrane Transport Proteins/genetics , Obsessive-Compulsive Disorder/genetics , Receptors, Serotonin/genetics , Serotonin Plasma Membrane Transport Proteins/genetics , Gene Frequency , Genotype , Mutation , Obsessive-Compulsive Disorder/drug therapy , Polymorphism, GeneticABSTRACT
The aim of this pilot study was to evaluate the effectiveness of cognitive-behavioral therapy (CBT) and use of amitriptyline, a tricyclic antidepressant, in patients with chronic temporomandibular disorders (TMD). Forty-seven women (mean age = 35.4 years old) with chronic TMD were enrolled in the study and divided into 4 groups: amitriptyline; amitriptyline and CBT; placebo and CBT; and placebo only (control). Patients were managed for 7 consecutive weeks. Follow-up evaluations were done at the 1st, 7th and 11th weeks of treatment. The presence and severity of pain, levels of depression, and quality of life and sleep were measured. Data were analyzed using ANOVA, Chi-square and Cochran tests, considering a significance level of 5 percent. Improvements were found for all factors considered in the intragroup analysis, although no significant differences were detected among groups. However, at the end of the treatment (11 weeks of follow-up), these positive outcomes persisted only for the women treated with amitriptyline and CBT. The obtained results suggest that the combination of amitriptyline and CBT may be effective in reducing pain and depression levels as well as in improving the quality of life and sleep in patients with chronic TMD.
O objetivo deste estudo piloto foi avaliar a eficácia do uso de uma terapia cognitivo comportamental (TCC) e da amitriptilina, um antidepressivo tricíclico, no tratamento de pacientes portadores de disfunções temporomandibulares (DTM) crônicas. Quarenta e sete mulheres (com 35,4 anos em média) diagnosticadas com DTM crônica foram selecionadas e divididas em 4 grupos: amitriptilina; amitriptilina + TCC; placebo + TCC; e placebo (controle) e controle. As pacientes foram submetidas às terapias por 7 semanas consecutivas. As reavaliações aconteceram 1, 7 e 11 semanas após o início da terapia (11 semanas de avaliações). Foram avaliados a presença e severidade de dor, o nível de depressão, a qualidade de vida e do sono. Os dados foram avaliados através de ANOVA, Qui-quadrado e teste de Cochran, considerando um nível de significância de 5 por cento. Foram observadas melhoras significantes em todos os fatores avaliados para todos os grupos, porém não foram observadas diferenças entre os grupos. Após o final da terapia, os resultados positivos persistiram apenas para o grupo amitriptilina + TCC. Os resultados sugerem que o uso associado de amitriptilina e TCC no tratamento de pacientes portadores de DTM crônicas pode ser efetivo na melhora da dor, nível de depressão, qualidade de vida e do sono.
Subject(s)
Adolescent , Adult , Female , Humans , Middle Aged , Young Adult , Amitriptyline/therapeutic use , Antidepressive Agents, Tricyclic/therapeutic use , Cognitive Behavioral Therapy , Temporomandibular Joint Disorders/therapy , Chronic Pain/classification , Chronic Pain/drug therapy , Chronic Pain/therapy , Depression/classification , Depression/drug therapy , Depression/therapy , Follow-Up Studies , Pain Measurement , Pilot Projects , Placebos , Quality of Life , Sleep Initiation and Maintenance Disorders/drug therapy , Sleep Initiation and Maintenance Disorders/therapy , Sleep/drug effects , Sleep/physiology , Treatment Outcome , Temporomandibular Joint Disorders/classification , Temporomandibular Joint Disorders/drug therapyABSTRACT
La cistitis intersticial se define como un síndrome clínico caracterizado por un incremento de la frecuencia urinaria, urgencia miccional y/o dolor abdominal o perineal en ausencia de infección urinaria o enfermedad conocida del aparato urinario. Se divide de acuerdo a los hallazgos citoscópicos en ulcerativa o no. La base del diagnóstico es clínica apoyada en scores de probabilidad y pruebas invasivas. Con la comprensión de la fisiopatología se ha desarrollado un abanico de posibilidades terapéuticas. Comunicamos el caso de una paciente sintomática por cuatro años con diagnóstico de cistitis intersticial con úlcera de Hunner por cistoscopia y excelente respuesta a la amitriptilina. Es una enfermedad que produce considerable alteración de la calidad de vida, por lo que es importante que los médicos estén familiarizados con este cuadro.
Interstitial cystitis is characterized by over 6 months of chronic pain, pressure and discomfort felt in the lower pelvis or bladder. It is often relieved with voiding, along with daytime frequency and nocturia in the absence of an urinary tract infection. The disorder can be divided clinically into two groups -ulcerative and non-ulcerative- based on cystoscopic findings and response to treatment. Management follows an approach of applying the least invasive therapy that affords sufficient relief of symptoms. We report a case of a patient with interstitial cystitis. The diagnosis was performed by symptoms and lesion in the cystoscopy and excellent response to amitriptyline.
Subject(s)
Adult , Female , Humans , Cystitis, Interstitial/diagnosis , Amitriptyline/therapeutic use , Antidepressive Agents, Tricyclic/therapeutic use , Cystitis, Interstitial/drug therapyABSTRACT
JUSTIFICATIVA E OBJETIVOS: A doença do refluxo gastroesofágico (DRGE) acomete frequentemente pacientes acima de 40 anos, é uma afecção crônica decorrente do fluxo retrógrado do conteúdo gastroduodenal para o esôfago ou órgãos adjacentes, levando a sinais esofágicos e extraesofágicos associados ou não a lesões teciduais. Os sintomas mais comuns são pirose, regurgitação, queimação retroesternal com irradiação para a garganta e ou epigástrio; porém podem ocorrer manifestações atípicas como: asma, bronquite, tosse, pneumonia de repetição, rouquidão, sinusite, laringite, otalgia crônicas, halitose, desgaste do esmalte dentário e sensação de nó na garganta. O objetivo deste estudo foi relatar o caso de paciente com epigastralgia e sensação de nó na garganta persistente, após a correção cirúrgica da hérnia de hiato e o uso de medicamentos, porém com melhora do quadro clínico com o uso amitriptilina e psicoterapia.RELATO DO CASO: Paciente do sexo masculino, 27 anos, solteiro, reside com a mãe e relata sintomas típicos e atípicos da DRGE, com exames diagnósticos normais, sem melhora, com intensidade 10 da dor pela escala visual numérica mesmo com medidas preventivas, tratamento cirúrgico e tratamento clínico com famotidina, tramadol e domperidona. A conduta da equipe de controle da dor foi continuar com as medidas preventivas e o tratamento medicamentoso, introduzir codeína, amitriptilina e psicoterapia, pois foi identificado um quadro de conflito com a mãe.CONCLUSÃO: O paciente apresentou melhora significativa da dor com o uso de amitriptilina, o que concorda com a literatura, pois ocorre melhora em 30% dos pacientes com o uso de antidepressivo tipo amitriptilina, em associação com medicamentos específicos usados no refluxo gastroesofágico como a domperidona e omeprazol.
BACKGROUND AND OBJECTIVES: Gastroesophageal reflux disease is common in patients above 40 years of age. It is a chronic affection caused by retrograde flow of gastroduodenal content to the esophagus or adjacent organs, leading to esophageal and extra-esophageal signs, associated or not to tissue injuries. Most common symptoms are pyrosis, regurgitation, retrosternal burning with irradiation to throat and/or epigastrium; however there may be atypical manifestations, such as asthma, bronchitis, cough, repetition pneumonia, hoarseness, sinusitis, laryngitis, chronic earache, halitosis, teeth enamel wear and sensation of knot in throat. This study aimed at reporting the case of a patient with epigastralgia and persistent sensation of knot in throat after surgical hiatal hernia correction and use of drugs, however with improvement of symptoms with amitriptyline and psychotherapy.CASE REPORT: Male patient, 27 years old, single and living with his mother, reporting typical and atypical GERD symptoms, with normal diagnostic tests, without improvement and with pain intensity 10 according to numerical visual scale even with preventive measures, surgical treatment and clinical treatment with famotidine, tramadol and domperidone. Pain control team approach was to maintain preventive measures and drug treatment, to introduce codeine and amitriptyline and psychotherapy because a conflict with his mother was identified.CONCLUSION: Patient had significant pain improvement with amitriptyline, which is in agreement with the literature because there is 30% improvement of patients with the use of amitriptyline-type antidepressants, associated to specific drugs used for gastroesophageal reflux, such as domperidone and omeprazol.
Subject(s)
Humans , Male , Adult , Amitriptyline/therapeutic use , Antidepressive Agents, Tricyclic/therapeutic use , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/psychology , Gastroesophageal Reflux/drug therapy , Pain Measurement , PsychotherapyABSTRACT
Prurido e dor são as principais manifestações clínicas das doenças vulvares. Estes sintomas podem estar associados a processos inflamatórios, imunológicos, distúrbios metabólicos e neoplasias. Na dúvida, é sempre recomendável o estudo histopatológico. Quando não há definição etiológica, várias opções terapêuticas estão disponíveis: cremes tópicos, fármacos sistêmicos, operações de dessensibilização nervosa da vulva. A conduta terapêutica deve ser individualizada quando não há etiologia definida. São escassos os trabalhos científicos, com metodologia adequada, que abordam o tema. Portanto, anamnese e exame físico cuidadosos irão definir a melhor abordagem terapêutica
Pruritus and pain are common manifestations of vulvae diseases. The symptoms can be associated with inflammatory, immunologic, metabolic or neoplastic diseases. Undoubtedly, the histopathological exam is always recommended. When there is no etiologic definition, many therapeutic options are available: creams, systemic drugs, and surgical neural desensitization of the vulvae. When there is no precise etiology, therapeutical approach must be individualized. Scientific studies, with good methodology, are rare. Therefore, careful anamnesis and physical exam will point to the best therapeutical approach
Subject(s)
Humans , Female , Vulvar Diseases/diagnosis , Vulvar Diseases/therapy , Pain/etiology , Pain/therapy , Physical Examination , Lidocaine/therapeutic use , Medical History Taking , Nortriptyline/therapeutic use , Pruritus Vulvae/etiology , Pruritus Vulvae/therapy , Antidepressive Agents, Tricyclic/therapeutic useABSTRACT
Introducción: El dolor neuropático es uno de los sindromes dolorosos más complejos. Su tratamiento farmacológico es refractario a los tratamientos convencionales, pero actualmente el uso de fármacos neuromoduladores, como los gabapentoides, han demostrado efectividad en el manejo analgésico de esta patología, no estando aún descritas en nuestro país las dosis terapéuticas de gabapentoides para el manejo del dolor neuropático. Objetivo: Determinar la dosis de gabapentoides utilizada en el manejo del dolor neuropático en pacientes ambulatorios atendidos en la unidad de dolor y cuidados paliativos del Hospital Clínico Universidad de Chile. Material: Se realizó un estudio descriptivo-prospectivo de los pacientes con diagnóstico de dolor neuropático, atendidos ambulatoriamente en la Unidad de Dolor y Cuidados Paliativos, durante el periodo marzo 2008 a febrero del 2009. Se realizó el tratamiento farmacológico en base al modelo de escalera analgésica. Luego del seguimiento, se analizaron variables demográficas, clínicas y el tratamiento farmacológico prescrito, definiéndose como eficacia analgésica, disminución en la intensidad del dolor en puntación de escala visual análoga, disminución de puntaje en cuestionario DN4, funcionalidad en escala Karnofsky y mejoría del insomnio. Se realizó análisis con test de Student y test de Wilcoxon para datos emparejados, en programa estadístico Stata versión 10.0 ®, considerando un p-value significativo <0.05. Resultados: Durante el periodo estudiado, ingresaron un total de 96 pacientes. De ellos, cumplieron con criterio de dolor neuropático definitivo y registros completos un total de 86 (89,6 por ciento), los que constituyeron la muestra final de este estudio. Se encontraron 62 (72,1 por ciento) pacientes de sexo femenino, con un promedio de edad de 55,3 +/- 14,8 (28-84) años y 24 (27,9 por ciento) pacientes de sexo masculino con edad promedio de 54,8 +/- 19,3 (18-84), sin diferencias significativas por sexo (p=0,88)...
Introduction: Neuropathic pain is one of the most complex pain disorders and also resistant to conventional drug therapy, however, the use of neuromodulating drugs such as gabapentoid dosage for managing neuropathic pain has not been described in Chile. Objetive: To determine the dose of gabapentoids to has to be used to manage neuropathic pain in outpatients undergoing treatment at the Pain and Palliative Care Unit of Universidad de Chile Hospital. Materials: A descriptive prospective study of outpatients of the Pain and Palliative Care Unit diagnosed with neuropathic pain was conducted within a period of time starting March 2008 through February 2009. Subsequently, demographic, clinical, and drug therapy variables were analyzed, defining as analgesia efficiency the reduction of pain intensity according to the visual analogue scale, a reduced DN4 questionnaire score, functionality in Karnofky scale, and improvements in terms of insomnia. Analysis was made using Student and Wilcoxon test for paired data in statistical program Stata 10.0 ®, with a significant p-value <0.05. Results: A total 96 patients were studied within the term mentioned above. From this total, 86 (89.6 percent) patients complied with a definitive neuropathic pain criterion and full records, wich were the final sample of this study. No significant differences per gender were found among the 62 (72.1 percent) female patients whose average age was 55.3 +/-14.8 (28-84) and the 24 (27.9 percent) male patients whose average age was 54.8 +/- 19.3 (18-84). The main diagnoses were lumbago (16 percent), but no differences per gender were found. The final doses determined after using gabapentoids were 693.3 +/- 367.4 mg. for gabapentin and 168.8 +/- 87.3 for pregabalin. In connection with the instruments applied, the intensity of pain scored according to EVA scale and DN4 scale were significantly reduced (p<0.01) in 61.1 percent (7.2 v/s 2.8) and 68.9 percent (5.8 v/s 1.8), respectively (figures 1...
Subject(s)
Humans , Male , Adult , Female , Young Adult , Middle Aged , Analgesics, Opioid/administration & dosage , Pain/drug therapy , Pain Management , Nervous System , Antidepressive Agents, Tricyclic/administration & dosage , Antidepressive Agents, Tricyclic/therapeutic use , Palliative Care/methods , Chemotherapy, Adjuvant/methodsABSTRACT
Prolactin is known to have significant immunomodulatory properties. Imipramine, a monoamine oxidase inhibitor, stimulates prolactin production because it decreases dopamine which inhibits secretion of prolactin. The study objective was to determine if use of imipramine can result in immunological benefits for HIV-positive patients by restoration and preservation of immunological function. A cohort of 19 retroviral positive patients was identified for the prospective study which continued for a 28-week period. Three patients dropped out before the study began. Inclusion criteria accepted only patients on the same highly active antiretroviral therapy (HAART) regimen for a nine-month period and who had reached a plateau with respect to the CD4 cell count and also had no prior history of antidepressant use for a 12-month period. This study had a "before and after" design, patients serving as their own control. The study drug imipramine was prescribed for a 12-week period up to visit 4, and then discontinued for 4-weeks (washout period) at which time blood investigations were done at visit 5. Finally, patients were prescribed the study drug for a further 12-week period to the end of the trial (visit 7). At the 95 per cent probability level, significant differences in average prolactin and CD4 levels from visit 4 to the end of the trial period were recorded. Results showed a trend of prolactin levels decreasing after washout (p = 0.015) and increasing by the end of the trial period once imipramine dispensation had recommenced (p = 0.006). With respect to the CD4 cell count, there was a significant increase after wash-out (p = 0.022). These results indicate a trend to immune boosting in HIV-positive patients who had obtained the maximum response from HAART.
Se sabe que la prolactina posee importantes propiedades inmunomudolatorias. La imipramina, un inhibidor de la monoamino oxidasa, estimula la producción de la prolactina porque disminuye la dopamina, que a su vez inhibe la secreción de prolactina. El objetivo de este estudio fue determinar si el uso de la imipramina puede traer beneficios inmunológicos a los pacientes VIH positivos mediante la restauración y preservación de la función inmunológica. Se identificó una cohorte de 19 pacientes retrovirales positivos, a fin de realizar este estudio prospectivo que continuó por un período de 28 semanas Tres pacientes se retiraron antes de que el estudio comenzara. Los criterios de inclusión aceptaban sólo pacientes que tuvieran el mismo régimen de terapia antiretroviral altamente activa (HAART) por un período de nueve meses, que hubieran alcanzado un nivel de estabilización con respecto al conteo de células CD4, y que no hubieran además tenido con anterioridad una historia de uso de anti-depresantes por espacio de 12 meses. Este estudio tuvo un diseño "antes y después", sirviendo los pacientes como su propio control. La imipramina para el estudio fue prescrita por un período de 12 semanas hasta la visita 4, y luego descontinuada por 4 semanas para un reposo farmacológico (período de lavado), realizándose entonces pruebas de sangre en la visita 5. Finalmente se prescribió el medicamento de estudio a los pacientes por un nuevo período de 12 semanas hasta el final del ensayo (visita 7). En el nivel de probabilidad del 95 por ciento, se registraron diferencias significativas en los niveles promedio de prolactina y CD4 desde la visita 4 hasta el final del período de ensayo. Los resultados mostraron una tendencia de los niveles de prolactina a descender tras el lavado (p = 0.015) y a aumentar hacia el final del período de ensayo, una vez que la dispensación de imipramina hubiese recomenzado (p = 0.006). Con respecto al conteo de células de CD4, hubo un aumento significativo luego del lavado (p = 0.022).