Relationship between optical coherence tomography findings and clinical variables in patients with opiate use disorder / Relação entre os achados da tomografia de coerência óptica e as variáveis clínicas em pacientes com transtorno por uso de opiáceos

ABSTRACT Purpose: This study aimed to examine optical coherence tomography findings in patients with opiate use disorder by comparing them with healthy controls. Methods: The study included 30 opiate use disorder patients and 30 controls. The participants' detailed biomicroscopic examinations, visual acuity, intraocular pressure, and both eye examinations were evaluated. A total of 120 eyes were evaluated using optical coherence tomography, measuring the central macular thickness, mean macular thickness, mean macular volume and retinal nerve fiber layer thickness. Moreover, all participants filled in the demographic data form and Barratt Impulsiveness Scale. Results: Upon examination of the optical coherence tomography findings, central macular thickness, mean macular thickness, and mean macular volume were thinner in both eyes in patients with opiate use disorder (p<0.01 in all measurements in both eyes). Similarly, the total values of the superior quadrant and retinal nerve fiber layer thickness were statistically significant in both eyes compared to that in the control group (p=0.007, p=0.002; p=0.049, p=0.007, in the right and left eyes, respectively). Only the left eye was positively correlated with retinal nerve fiber layer superior quadrant measurement and hospitalization (r=0.380, p=0.039). Conclusion: Our results revealed that the patients' central macular thickness, mean macular thickness, and mean macular volume values were thinner. Increase in the retinal nerve fiber layer thickness superior quadrant thickness and total value was also observed. Further studies with larger sampling groups that evaluate neuroimaging findings should be conducted.

RESUMO Objetivo: O objetivo foi investigar foi, os achados da tomografia de coerência óptica em pacientes com transtorno do uso de opiáceos, comparando-os com controles saudáveis. Métodos: O estudo incluiu 30 pacientes com transtorno do uso de opiáceos e 30 controles. Os exames biomicroscópicos detalhados de todos os participantes, acuidade visual, pressão intraocular e ambos os exames oculares foram avaliados com tomografia de coerência óptica. Um total de 120 olhos foram avaliados usando tomografia de coerência óptica, e a espessura macular central, espessura macular média, volume macular médio e a espessura da camada de fibra nervosa da retina dos participantes foram medidos. Além disso, todos os participantes preencheram o Formulário de Dados Demográficos e a Escala de Impulsividade Barratt (BIS-11). Resultados: Quando os achados de tomografia de coerência óptica foram examinados, espessura macular central, espessura macular média e volume macular médio eram mais finos de acordo com controles saudáveis em ambos os olhos em pacientes com transtorno do uso de opiáceos (p<0,01 em todas as medições em ambos os olhos). Da mesma forma, os valores totais do quadrante superior e espessura da camada de fibra nervosa da retina estavam mais em níveis estatisticamente significativos em ambos os olhos em comparação com o grupo controle (p=0,007, p=0,002; p=0,049, p=0,007, no olho direito e esquerdo, respectivamente). Estar internado em hospital e apenas a medida do quadrante superior da espessura da camada de fibra nervosa da retina do olho esquerdo associou-se positivamente (r=0,380, p=0,039). Conclusão: Em nossos resultados, descobrimos que os valores de espessura macular central, espessura macular média e volume macular médio dos pacientes eram mais finos. Verificamos também espessamento no quadrante superior e valor total da espessura da camada de fibra nervosa da retina. Nosso estudo deve ser apoiado por novos estudos com grupos de amostragem maiores, nos quais os achados de neuroimagem são avaliados.

Regional analgesia and surgical site infections after colorectal surgery: a retrospective cohort analysis

Abstract Background The effect of regional analgesia on perioperative infectious complications remains unknown. We therefore tested the hypothesis that a composite of serious infections after colorectal surgery is less common in patients with regional analgesia than in those given Intravenous Patient-Controlled Analgesia (IV-PCA) with opiates. Methods Patients undergoing elective colorectal surgery lasting one hour or more under general anesthesia at the Cleveland Clinic Main Campus between 2009 and 2015 were included in this retrospective analysis. Exposures were defined as regional postoperative analgesia with epidurals or Transversus Abdominis Plane blocks (TAP); or IV-PCA with opiates only. The outcome was defined as a composite of in-hospital serious infections, including intraabdominal abscess, pelvic abscess, deep or organ-space Surgical Site Infection (SSI), clostridium difficile, pneumonia, or sepsis. Logistic regression model adjusted for the imbalanced potential confounding factors among the subset of matched surgeries was used to report the odds ratios along with 95% confidence limits. The significance criterion was p < 0.05. Results A total of 7811 patients met inclusion and exclusion criteria of which we successfully matched 681 regional anesthesia patients to 2862 IV-PCA only patients based on propensity scores derived from potential confounding factors. There were 82 (12%) in-hospital postoperative serious infections in the regional analgesia group vs. 285 (10%) in IV-PCA patients. Regional analgesia was not significantly associated with serious infection (odds ratio: 1.14; 95% Confidence Interval 0.87‒1.49; p-value = 0.339) after adjusting for surgical duration and volume of intraoperative crystalloids. Conclusion Regional analgesia should not be selected as postoperative analgesic technique to reduce infections.

Riesgo de la prescripción de opioides para el manejo del dolor / Risk of Opioid Prescriptions for Management of Pain / Risco de prescrição de opioides para o tratamento da dor

actualmente existe una intensa prescripción de opioides para el manejo de todo tipo de dolor a nivel clínico, razón por la cual es importante considerar los posibles daños derivados de esta actividad, tales como tolerancia, adicción, dependencia y sobredosis. La medicación de opiáceos o sus derivados de manera irracional para el manejo del dolor agudo o crónico puede ser la puerta de entrada a las drogodependencias. Muchos adictos a opiáceos informaron haber estado expuestos por primera vez a los opioides a través de una prescripción médica para el tratamiento del dolor. Por ello, es importante evaluar por parte de los profesionales de la salud el uso a largo plazo de estos medicamentos para el manejo del dolor, porque estudios han evidenciado una relación entre el uso clínico y la dependencia de estos, sobre todo en adolescentes y adultos jóvenes sin experiencia en opiáceos que fueron sometidos a procedimientos quirúrgicos y dentales.

Currently, opioids for managing all types of pain are increasingly prescribed at the clinical level, which is why it is important to consider the potential harms derived from this practice, such as tolerance, addiction, dependence, and overdose. Irrational medication of opioids or opioid derivatives for acute or chronic pain management can be the gateway to drug dependence. Many opioid addicts reported first being exposed to opioids after receiving a physician's prescription for pain management. Therefore, health professionals need to evaluate the long-term use of these medications to manage pain because studies have shown a relationship between clinical use and opioid dependence, especially in adolescents and young adults who had never received opioid therapy and who underwent surgical and dental procedures

Atualmente existe uma intensa prescrição de opioides para o manejo de todos os tipos de dor em nível clínico, por isso é importante considerar os possíveis danos decorrentes dessa atividade, como tolerância, adição, dependência e overdose. A medicação de opiáceos ou seus derivados de forma irracional para o manejo da dor aguda ou crônica pode ser a porta de entrada para a adição a drogas. Muitos dependentes de opioides relataram ter sido expostos a opioides pela primeira vez por meio de uma receita médica para o tratamento da dor. Por esse motivo, é importante que os profissionais de saúde avaliem o uso prolongado desses medicamentos para o manejo da dor, pois estudos têm mostrado relação entre o uso clínico e a dependência dos mesmos, principalmente em adolescentes e adultos jovens sem experiência com opioides que foram submetidos a procedimentos cirúrgicos e odontológicos

Caso clínico: Diagnóstico de alergia a relajantes musculares y opiáceos / Case report: Diagnosis of allergy to muscle relaxants and opiates

The anesthesiologist is the specialist who most often faces allergic reactions due to the number of drugs and substances that are exposed to the patient during the course of an intervention. Although they are rare, they have a mortality rate between 3% and 10%. We present a clinical case of a 42-year-old woman with a history of anaphylactic reaction grade 2 that is coordinated for a Werthein-Meigs surgery, for which it is decided to test her with skin tests. The results were positive for morphine, fentanil, remifentanil and atracurium, which directly affected the perioperative management.

El anestesiólogo es el especialista que con mayor frecuencia se enfrenta a reacciones alérgicas por el número de fármacos y sustancias a las que se expone al paciente en el transcurso de una intervención. Si bien son poco frecuentes presentan una mortalidad entre 3 a 10%. Presentamos un caso clínico de una mujer de 42 años con un antecedente de reaccion anafiláctica grado 2 que se coordina para una cirugía de Werthein- Meigs, por lo cual se decide testearla con pruebas cutáneas. Los rsultados fueron positivos para morfina, fentani, remifentanil y atracurio, lo cual incidió directamente en el manejo perioperatorio.

Anestesia intraarticular. Una revisión sistemática / Intra-articular anesthesia. A systematic review

Las enfermedades reumáticas, debido a su evolución natural, traen consigo afectaciones a la calidad de vida de las personas portadoras de las afecciones, por lo que resulta de vital importancia su diagnóstico temprano, el tratamiento oportuno y la prevención. El conocimiento de los adelantos contemporáneos en la atención de salud es una herramienta de ayuda a la hora de tomar decisiones clínicas en la práctica diaria, aunque la decisión final sobre el abordaje diagnóstico o terapéutico de un paciente concreto dependerá de las características del mismo. Objetivo: realizar una revisión sistemática de la literatura especializada sobre la anestesia intraarticular. Desarrollo: se consultaron 56 artículos entre originales o de resultados de investigación, revisiones sistemáticas de los últimos 15 años, tomándose en cuenta las publicaciones relacionadas con la anestesia intraarticular publicadas desde 2007 a la actualidad. Fueron excluidos aquellos artículos o publicaciones dirigidas a los directores de revista u otros documentos que no aporten datos significativos. Además, se excluyeron los informes cuyos resultados no se correspondían con el primer y segundo nivel de evidencia o se desarrollaron en animales. Conclusiones: las investigaciones y la evidencia apoyan el uso de bupivacaina en su forma simple o combinada, resultando este el más empleado, aunque se señala la incorporación de un nuevo anestésico local con menos toxicidad, mayor seguridad que no afecta la función cardíaca conocido como poiovacaina los opiáceos como la morfina y el midazolam por vía intraarticular resultan los anestésicos locales preferidos para las intervenciones intra articulares por su efecto analgésico en el postoperatorio(AU)

Rheumatic diseases, due to their natural evolution, bring with them affectations to the quality of life of the people carriers of the affections, reason why their early diagnosis, the opportune treatment and the prevention are of vital importance. The knowledge of contemporary advances in health care is a tool to help when making clinical decisions in daily practice, although the final decision on the diagnostic or therapeutic approach of a specific patient will depend on the characteristics of the same. Objective: to carry out a systematic review of the specialized literature on intra-articular anesthesia. Development: 56 articles were consulted between originals or research results, systematic reviews of the last 15 years, taking into account the publications related to intra-articular anesthesia published from 2007 to the present. Those articles or publications addressed to magazine directors or other documents that do not provide significant data were excluded. In addition, reports whose results did not correspond to the first and second level of evidence or were developed in animals were excluded. Conclusions: research and evidence support the use of bupivacaine in its simple or combined form, which is the most commonly used, although the incorporation of a new local anesthetic with less toxicity, greater safety that does not affect cardiac function known as poiovacaine, is indicated. Opiates such as morphine and midazolam intra-articularly are the preferred local anesthetics for intra-articular interventions because of their analgesic effect in the postoperative period(AU)

Anafilaxia a morfina e tramadol: relato de caso / Anaphylactic reaction to morphine and tramadol: case report

A investigação diagnóstica de reações anafiláticas durante a anestesia é difícil, uma vez que vários medicamentos são administrados. O diagnóstico é necessário para evitar uma reexposição ao medicamento potencialmente ofensivo. Os opioides raramente causam anafilaxia. A incidência total de reação de hipersensibilidade imediata aos opiáceos é desconhecida, e as incidências diferenciais de reações alérgicas e não alérgicas aos opiáceos também. Os dados sobre a sensibilidade cruzada entre as classes de medicamentos são limitados pela ocorrência rara destas alergias, e qualquer uso de opioide em um paciente com alergia relatada deve ser feito com cautela. O valor dos testes cutâneos de leitura imediata nos indivíduos sensíveis aos opiáceos é incerto, por poderem causar desgranulação direta dos mastócitos, e o teste de IgE sérico para opiáceos não está disponível comercialmente. O objetivo dos autores é relatar um caso de anafilaxia perioperatória, tendo como agente causal um opioide e discorrer sobre a investigação e implicações decorrentes do uso destes medicamentos. Estudos bem desenhados e adequadamente controlados sobre o assunto ainda são necessários para melhor entendimento das reações e maior segurança para o uso destes medicamentos.

Diagnostic investigation of anaphylactic reactions during anesthesia is difficult, since several drugs are administered simultaneously. However, diagnosis is necessary to avoid reexposure to potentially harmful drugs. Opioids rarely cause anaphylaxis. The overall incidence of immediate hypersensitivity reactions to opiates is unknown, as are the differential incidences of allergic and non-allergic reactions. Data on cross-sensitivity between different classes of drugs are limited by the rare occurrence of these allergies, and any use of opioids in a patient with a reported history of allergy should be made with caution. The value of immediate-reading skin tests in opiate-sensitive individuals is uncertain, as they may cause direct degranulation of mast cells; serum-specific IgE testing for opiates, in turn, is not commercially available. The objective of this study was to report a case of perioperative anaphylaxis to opioid and to discuss the diagnostic investigation and implications of the use of these drugs. Well-designed and adequately controlled studies are needed to improve our understanding of reactions to these drugs and to make their use safer.

Epidemiología de las intoxicaciones agudas por drogas de abuso en las urgencias de un hospital del Centro de España basada en datos de análisis toxicológico de orina / Epidemiology of acute poisonings for drugs of abuse in the emergency room of a hospital from the Center of Spain based on analysis data toxicological urine

Introducción: las intoxicaciones agudas son motivo de consulta cada vez más frecuente en los Servicios de Urgencia hospitalarios (SUH) debido a la mayor disponibilidad y acceso a productos químicos tóxicos. Se observan diferentes patrones en cada área sanitaria según el tipo de población, geografía y perfil epidemiológico de consumo. Material y métodos: el objetivo de nuestro estudio es realizar un perfil epidemiológico y describir el manejo del paciente que acude por clínica compatible con intoxicación aguda por drogas de abuso (IA) basado en la determinación de tóxicos en orina para seis sustancias (cannabis, opiáceos, cocaína, anfetaminas, benzodiazepinas y éxtasis) solicitados en el período de estudio 2010-2012. Resultados: se solicitaron 2755 peticiones, de las cuales fueron positivas 1429, y se estudiaron al azar 661 historias clínicas. El perfil de paciente intoxicado de nuestra área es el de varón de entre 30 y 40 años, consumidor preferentemente de cannabis y cocaína; las benzodiazepinas son el tóxico más frecuente en las mujeres, con clínica mayoritariamente neurológica, sin diferencias en cuanto a la franja horaria o el mes del año en que recibió el alta desde el propio SUH en casi el 60% de los casos. Discusión: las IA en los SUH representan casi el 1% de las consultas y tienen una escasa mortalidad. En algunos casos, el médico de urgencias comienza el tratamiento antes de conocer el resultado toxicológico, lo que nos hace plantearnos la utilidad real y el coste-efectividad de estas determinaciones en todos los pacientes con alteración del nivel de conciencia. (AU)

Introduction: acute intoxications are a rising and common query demand on the emergency rooms because of the easy access and disponibility to toxic substances, where we can observe different patterns attending to type of population, geography and epidemiologic consume profile. Material and methods: our objective is to analyze the epidemiology and patient handling coming to the Emergency Room (ER) with compatible symptoms of street drugs abuse, based on the determination of cannabis, cocaine, amphetamine, benzodiazepine, opiates and ectasy urine levels in the period 2010-2012. Results: the ER requested 2755 determinations being positive 1429 and randomly examined 661 clinical histories. The profile of intoxicated patient was male, 30 to 40 years old, preferently cannabis and cocaine consumer (benzodiazepine in women), mostly with neurological symptoms when arrive, without differences between months or day time and, almost 60% of them, discharged directly from the ER. Conclusions: acute intoxications barely represent 1% of ER demands and produce poor or scarce mortality. Sometimes, doctors in charge start with therapeutic measures before knowing the results of toxicology, what leads us to ask about actual usefulness and cost-efficiency of the toxicology assay to every patient with low conscious level. (AU)

Guía de práctica clínica para el diagnóstico y tratamiento de lumbalgia / Clinical practice guideline for the diagnosis and treatment of low back pain

La lumbalgia es un síndrome muy prevalente en la población general, y en algunos casos se convierte en una patología crónica con múltiples limitaciones. La lumbalgia requiere un manejo interdisciplinario y complejo, y la pérdida laboral de horas-hombre es alta. Debido a estas consideraciones, el Sistema de Salud Público Peruano (EsSalud, Ministerio de Salud, Fuerzas Armadas y Policiales) apunta a hacer más eficiente el uso de recursos para el manejo de lumbalgia.

Adding 75 mg pregabalin to analgesic regimen reduces pain scores and opioid consumption in adults following percutaneous nephrolithotomy / Adição de 75 mg de pregabalina ao regime analgésico reduz escores de dor e consumo de opiáceos em adultos após nefrolitotomia percutânea / La adición de 75 mg de pregabalina al régimen analgésico reduce puntuaciones de dolor y consumo de opiáceos en adultos después de la nefrolitotomía percutánea

Background and objectives: Adding novel adjunctive drugs like gabapentinoids to multimodal analgesic regimen might be reasonable for lessening postoperative pain scores, total opioid consumption and side effects after percutaneous nephrolithotomy. We aimed to evaluate the effect of pregabalin on postoperative pain scores, analgesic consumption and renal functions expressed by creatinine clearance (CrCl) and blood neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C (Cys C) levels in patients undergoing percutaneous nephrolithotomy (PCNL). Methods: 60 patients undergoing elective PCNL were enrolled in the study. Patients were randomized to oral single dose 75 mg pregabalin group and a control group. Visual Analog Scale pain scores (VAS), postoperative intravenous morphine consumption during the first 24 postoperative hours, serum NGAL, Cys C levels and creatinine clearance (CrCl) was measured preoperatively and post-operatively at 2nd and 24th hour. Results: Postoperative VAS scores were significantly decreased in the pregabalin group at the postoperative 30th min, 1st, and 2nd hour (p = 0.002, p = 0.001 and p = 0.027, respectively). Postoperative mean morphine consumption was statistically significantly decreased for all time intervals in the pregabalin group (p = 0.002, p = 0.001, p = 0.001, p = 0.001, p < 0.001, respectively). No statistically significant differences were found between the two groups with regard to CrCl, or Cys C at preoperative and postoperative 2nd and 24th hour. Postoperative 24th hour NGAL levels were significantly decreased in the pregabalin group (p = 0.027). Conclusions: Oral single-dose preemptive 75 mg pregabalin was effective in reducing early postoperative pain scores and total analgesic consumption in patients undergoing PCNL without leading to hemodynamic instability and side effects. .

Justificativa e objetivos: A adição de novos medicamentos adjuvantes, como os gabapentinoides, ao regime analgésico multimodal pode ser razoável para diminuir os escores de dor no pós-operatório, o consumo total de opiáceos e os efeitos colaterais após nefrolitotomia percutânea. Nosso objetivo foi avaliar durante o período pós-operatório o efeito de pregabalina nos escores de dor, consumo de analgésicos e funções renais expressas por clearance de creatinina (ClCr) e níveis séricos de cistatina-C (Cis-C) e lipocalina associada à gelatinase de neutrófilos (LAGN) em pacientes submetidos à nefrolitotomia percutânea (NLPC). Métodos: Sessenta pacientes submetidos à NLPC eletiva foram incluídos no estudo. Os pacientes foram randomizados para receber pregabalina oral em dose única de 75 mg – grupo pregabalina e grupo controle. Os escores de dor medidos pela Escala Visual Analógica (EVA), o consumo de morfina intravenosa nas primeiras 24 horas de pós-operatório, LAGN sérico, níveis de Cis-C e clearance de creatinina (ClCr) foram mensurados no pré-operátorio e na segunda e 24a horas de pós-operatório. Resultados: Os escores EVA no pós-operatório foram significativamente menores no grupo pregabalina nos tempos de 30 min, 1 e 2 horas (p = 0,002, p = 0,001 e p = 0,027, respectivamente). A média do consumo de morfina no pós-operatório foi estatisticamente significante menor em todos os intervalos de tempo no grupo pregabalina (p = 0,002, p = 0,001, p = 0,001, p = 0,001, p < 0,001, respectivamente). Não houve diferença estatisticamente significante entre os dois grupos em relação ao ClCr ou Cis-C no pré-operatório e na segunda e 24a horas de pós-operatório. Os níveis de LAGN na 24a hora de pós-...

Justificación y objetivos: La adición de nuevos medicamentos adyuvantes, como los gabapentinoides, al régimen analgésico multimodal puede ser interesante para poder disminuir las puntuaciones de dolor en el postoperatorio, el consumo total de opiáceos y los efectos colaterales después de la nefrolitotomía percutánea. Nuestro objetivo fue evaluar, durante el período postoperatorio, el efecto de la pregabalina en las puntuaciones de dolor, consumo de analgésicos y funciones renales expresadas por aclaramiento de creatinina y niveles séricos de cistatina-C y lipocalina asociada con la gelatinasa de neutrófilos en pacientes sometidos a la nefrolitotomía percutánea. Métodos: Sesenta pacientes sometidos a nefrolitotomía percutánea electiva fueron incluidos en el estudio. Los pacientes fueron aleatorizados para recibir pregabalina oral en dosis única de 75 mg (grupo pregabalina) y grupo control. Las puntuaciones de dolor medidas por la escala visual analógica, el consumo de morfina intravenosa en las primeras 24 h de postoperatorio, nivel sérico de lipocalina asociada a la gelatinasa de neutrófilos, niveles de cistatina-C y aclaramiento de creatinina fueron medidos en el preoperatorio y en la 2.a y 24.a horas del postoperatorio. Resultados: Las puntuaciones de la escala visual analógica en el postoperatorio fueron significativamente menores en el grupo pregabalina a los 30 min, 1 y 2 h (p = 0,002; p = 0,001; y p = 0,027 respectivamente). El promedio del consumo de morfina en el postoperatorio fue estadísticamente significativo y menor en todos los intervalos de tiempo en el grupo pregabalina (p = 0,002; p = 0,001; p = 0,001; p = 0,001; p < 0,001 respectivamente). No hubo diferencia estadísticamente significativa entre los 2 grupos con relación al aclaramiento de creatinina o cistatina-C en el preoperatorio y en ...

A aspirina, os opiáceos e a maconha no sistema endógeno de controle da dor / Aspirin, opiates and marijuana in the system of endogenous pain control

Tradução de Diego Molina e revisão do Prof. Dr. Luiz Roberto Giorgetti de Britto. O original em espanhol - "La aspirina, los opioides y la marijuana en el sistema endógeno de control del dolor" - encontra-se à disposição do leitor no Instituto de Estudos Avançados da USP para eventual consulta.

[Comparing ultra rapid opiate detoxification with Methadone in recurrent of self-introduced addicted subjects]

The common detoxification method is replacement of long effect opiate by short effect opiate and then reducing its amount gradually. More modern method is ultra rapid opiate detoxification [UROD] by opiate antagonists, which is performed by general anesthesia. The advantages of two methods have not been confirmed. This study aimed to compare effectiveness and withdrawal rate in both methods following up to a year. 211 self-introduced patients who referred to Farabi hospital for withdrawal were enrolled in this cross sectional study during 2005-06. The patients underwent detoxification after psychiatry screening and addiction confirmation. They divided into two detoxified method groups [110 patients in UROD and 101 Methadone]. Recurrent and suspected cases were confirmed or rejected by urinary test and more specific test respectively. Data was collected from available patients profiles and contacting with patients or their relatives and was analyzed using Chi-square and independent sample T-test. The results showed that addiction recurrent in UROD and Methadone groups was 35.7% and 56.4% respectively [P=0.002]. The average age of recurrent subjects in UROD group was younger than successful population at that same group [27.95 +/- 5.2 vs. 31.4 +/- 7.1 years old, p=0.008]. This study suggested that chance of detoxification and successful withdrawal by UROD method is higher than Methadone method and younger patients are more likely to get the recurrence. It is recommended to compare these two methods in a prospective study by unifying both groups based on age and considering opiate use duration

Macromolecules and pharmacy; coordinate covalent bonds between curiosity

Curiosity is the nature of man and availability of chance favor the prepared mind to explore the hidden things in the universe. One thought, observation or experience is based for the others. Chemistry is mother of the different disciplines. Macromolecules [carbohydrates, proteins, lipids etc], substitution of different group [R=Alklyl, Aryl etc] in their molecules changes their therapeutic efficacy and pharmacokinetics. Stereoisomerism in macromolecules structures, role of liposome's in penetration of drugs in cosmetics, percentage yield and antibiotics from natural moulds plays an important and significant role in pharmacy. The object is to find out a relationship between curiosity, macromolecules and pharmacy which might be able to clear the concept about mechanism of action of drugs, discovery of the new drugs and to understand pharmacological and adverse effects of drugs. This might be helpful in therapeutic management, follow up and better health care of patients in future

Pattern and frequency of acute poisoning in children

To determine different agents involved in acute poisoning in children, determine time interval between ingestion of agent and report at the hospital and document its hospital outcome. This was descriptive case series study conducted at the Department of Paediatrics [Emergency and General Wards], Khyber Teaching Hospital, Peshawar from Jan 2007 to July 2007. A total of hundred patients with history of acute poisoning were subjected to detailed history and examination regarding different aetiological agents, time interval between ingestion of agent and report at hospital and hospital outcome. Majority of patients were below six years of age, 69% were male while 31% were female. Pharmaceutical agents and kerosene oil poisoning were the leading cause constituting 29% each followed by opiate and organophosphorus constituting 17% and 15% respectively. Fifty three percent of cases belonged to urban while forty seven percent belonged to rural area. Forty percent of cases were brought to the hospital within first hour; followed by 38% and 22% in 1-6 and more than 6 hours respectively. Ninety four percent of patients were discharged with almost complete recovery while six percent expired during hospital stay. Acute poisoning is an important paediatric medical emergency and has got an important effect on morbidity and mortality in this age group. Toddlers are the most prone group in children to acute poisoning. Kerosene oil, drugs, organophosphorus and opiate are the common aetiological agents of poisoning in children. Hospital outcome is poor in patients with corrosives poisoning

Frequency distribution of opiate poisoning according to individual characteristics and clinical manifestations

Opiates include natural alkaloids and synthetic derivates. Their pharmacologic effects are based on bounding opiate receptors. Peak toxic and therapeutic effect of opiate is 90 minutes after oral administration. Acute presentations of opiate poisoning are CNS, respiratory and Gl involvements. In long term, opiate can change numbers and sensitivity of their receptors, and result in tolerance or withdrawal syndrome. In opiate over dosage, morbidity and mortality decrease with careful therapeutic and supportive managements. Study of frequency distribution of opiate poisoning according to individual characteristics and clinical manifestations are the main objectives of recent investigation. in this retrospective descriptive study, 2520 patients were enrolled in 2001-2002. Information including demographic and clinical characteristics of the subjects was collected. 263 cases of 2520 [10.4%] were poisoned with opiates. The most frequent age group was 21-30 years old [38.3%] and the most common hospital stay was 1-7 days [55.8%]. The males were more poisoned than female [71.4%] and respiratory support was used for 29 patients [18%]. Poisoning route was often [68.8%] by ingestion [181 cases]. The most common clinical presentation was CNS involvement [74.1%]. The most common type of used narcotic substances was opium [60.4%]. Mortality rate was 4.5% [12 cases]. Opiate poisoning can result in morbidity and mortality. Complications were more among those who referred to hospital with delay or used high dose or potent agents. The main cause of mortality in opiate overdose was hypoxia with respiratory depression

Undetected drug addict fatalities

Hair analysis screening in 21 fatalities with an unnatural or unknown cause of death [19-48 years of age] was carried out to evaluate the proportion of undetected drug-related cases. Among 21 hair samples tested, 2 [9.5%] were positive for three of the four opiates studied indicating past opiate use although examination, investigation and toxicology analyses failed to uncover evidence of drug abuse. Codeine alone and in combination with dihydrocodeine [DHC] were detected in the roots and 1 centimeter segments of hair of one case, respectively, while morphine and codeine were detected in the six centimeters of hair of the other case. The hair opiate concentrations coincides with that previously reported in cases of death due to acute narcotic intoxication. So, the present results raises certain issues regarding the use of hair as a matrix for postmortem toxicology testing. It can play an important role in determining the factors that caused or contributed to an individual's death in fatalities with undetermined cause of death

Balanced anesthesia with nalbuphine hydrochloride in pediatric patients : preliminary study

This study of the clinical use of nalbuphine as a component of a balanced anesthesia technique was undertaken with the purpose of exploring the feasibility and safety of this drug as well as to establish possible guidelines for its use.