Uso de drogas vasoativas e a sua relação com a intolerância dietoterápica / Use of vasoactive drugs and its relationship with intolerance of diet therapy

Investigar o uso de drogas vasoativas e a sua relação com a intolerância dietoterápica em pacientes críticos. Métodos: Trata-se de um estudo longitudinal retrospectivo realizado em unidades de terapia intensiva (UTIs) de um hospital público de Goiânia, no período de setembro de 2020 a junho de 2021. Realizou-se o levantamento de dados em prontuários eletrônicos do início da terapia nutricional enteral (TNE) correlato ao uso de droga vasoativa (DVA) até o 3° dia de internação. Resultados: A análise incluiu 40 pacientes, observou-se a prevalência do sexo masculino (72,50%) e a média de idade observada foi de 53,67 ± 19,86 anos. Nesse estudo o uso de uma DVA (77,50%) foi mais prevalente do que o uso de duas ou mais DVAs. Verificou-se uma relação significativa entre desfecho clínico e uso de DVA, de modo que, o óbito foi mais frequente naqueles que usavam duas ou mais DVAs (p=0,016). Também foi observada a associação entre a hipoglicemia e o uso de DVA. Essa intercorrência foi frequente naqueles com uso de duas ou mais DVAs (p=0,030). O uso de DVA não se associou a intolerância dietoterápica, porém observamos que a obstipação foi a intercorrência mais prevalente (42,50%). Conclusão: O uso de DVA não se associou a intolerância dietoterápica nessa amostra. Porém observamos uma relação significativa entre o uso de DVA e o óbito. Ainda, verificou-se que a hipoglicemia também se relacionou ao uso de DVA

To investigate the use of vasoactive drugs and its relationship with dietary intolerance in critically ill patients. Methods: This is a retrospective longitudinal study carried out in intensive care units (ICUs) of a public hospital in Goiânia, from September 2020 to June 2021. Data were collected from electronic medical records from the beginning of the enteral nutritional therapy (ENT) correlated with the use of vasoactive drugs (VAD) until the 3rd day of hospitalization. Results: The analysis included 40 patients, there was a prevalence of males (72.50%) and the mean age observed was 53.67 ± 19.86 years. In this study, the use of one VAD (77.50%) was more prevalent than the use of two or more VADs. There was a significant relationship between clinical outcome and use of VAD, so that death was more frequent in those who used two or more VADs (p=0.016). An association between hypoglycemia and the use of VAD was also observed. This complication was more frequent in those using two or more VADs (p=0.030). The use of VAD was not associated with gastrointestinal intolerance (GI), but we observed that constipation was the most prevalent complication (42.50%). Conclusion: The use of VAD was not associated with GA in this sample. However, we observed a significant relationship between the use of VAD and death. Furthermore, it was found that hypoglycemia was also related to the use of VAD

Uso de testosterona en mujeres: un comentario sobre el consenso global sobre el uso de la terapia de testosterona para mujeres / Global consensus position statement on the use of testosterone therapy for women

Las mujeres han sido tratadas por décadas con testosterona intentando aliviar una gran variedad de síntomas con riesgos y beneficios inciertos. En la mayoría de los países, la testosterona se prescribe "off-label", de modo que las mujeres están utilizando compuestos y dosis ideadas para tratamientos en hombres. En este sentido, varias sociedades médicas de distintos continentes adoptaron recientemente por consenso una toma de posición sobre los beneficios y potenciales riesgos de la terapia con testosterona en la mujer, explorar las áreas de incertidumbre e identificar prácticas de prescripción con potencial de causar daño. Las recomendaciones con respecto a los beneficios y riesgos de la terapia con testosterona se basan en los resultados de ensayos clínicos controlados con placebo de al menos 12 semanas de duración. A continuación se comentan las recomendaciones. (AU)

There are currently no clear established indications for testosterone replacement therapy for women. Nonetheless, clinicians have been treating women with testosterone to alleviate a variety of symptoms for decades with uncertainty regarding its benefits and risks. In most countries, testosterone therapy is prescribed off-label, which means that women are using testosterone formulations or compounds approved for men with a modified dose for women. Due to these issues, there was a need for a global Consensus Position Statement on testosterone therapy for women based on the available evidence from placebo randomized controlled trials (RCTs). This Position Statement was developed to inform health care professionals about the benefits and potential risks of testosterone therapy intended for women. The aim of the Consensus was to provide clear guidance as to which women might benefit from testosterone therapy; to identify symptoms, signs, and certain conditions for which the evidence does not support the prescription of testosterone; to explore areas of uncertainty, and to identify any prescribing practices that have the potential to cause harm. (AU)

Drogas asociadas a enfermedad pleural / Associated drugs to pleural disease

Está bien documentado que las drogas pueden producir enfermedades de la pleura. Si bien hay alrededor de treinta drogas a las que se las relaciona claramente con afectación pleural, también hay que considerar que toda droga puede, potencialmente, comprometer la pleura y, si no hay otra causa evidente de enfermedad pleural, se debe tener presente esta causa. El daño puede darse en forma independiente en la pleura o coexistir con el del parénquima pulmonar. La mayoría de los casos se resuelve al suspender la droga y, en otras ocasiones, se deben agregar esteroides. En este artículo se realiza un agrupamiento de las drogas que producen esta patología, una descripción y las características de cada una de ellas, y el manejo terapéutico adecuado de las que más frecuentemente se hallan involucradas.

It's well known that drugs can produce pleural diseases. There are about thirty drugs which are associated with them, but any drug, potentially, may cause pleural disease. Pleural damage may happen as an independent form or coexists with pulmonary parenchyma injury. Most cases are resolute when drug is discontinued, but every times we have to add steroids. In this article we group them, their characteristics are described, and we give a treatment guide of more common drugs which cause pleural diseases.

Tratamento medicamentoso do infarto agudo do miocárdio no Hospital de Clínicas de Porto Alegre / Drug therapy for acute myocardial infarction at Hospital de Clinicas de Porto Alegre, RS-Brazil

Determinar a taxa de prescrição de trombolíticos, aspirina, beta-bloqueadorese inibidores de enzima conversora da angiotensina na fase aguda do infarto, no caso dos três últimos fármacos citados, na profilaxia secundária do infarto agudo do miocárdio...

Recent advances in the treatment of congestive heart failure.

Treatment of heart failure should include correction of the underlying cause. These causes include large left to right shunts, obstructive lesions, arrhythmias, primary myocardial disease etc. The main pharmacological therapy includes inotropic agents, vasodilators and diuretics. Inotropic agents increase myocardial contractility and include digoxin, intravenous dopamine, dobutamine and isoproterenol. Vasodilators improve cardiac pump performance by decreasing the vascular resistance and/or increasing the venous capacitance. Commonly used vasodilator agents include angiotensin converting enzyme inhibitors (captopril, enalapril etc.), hydralazine, prazosin hydrochloride etc. Diuretics inhibit salt and water reabsorption promoting their excretion. Furosemide, thiazide diuretics, aldactone, are commonly used diuretics. Electrolyte and acid-base imbalance can occur on chronic diuretic therapy. Cardiac transplantation is considered for patients where all medical management has failed.