Use of remifentanil to reduce propofol injection pain and the required propofol dose in upper digestive tract endoscopy diagnostic tests / Uso do remifentanil para redução da dor à injeção de propofol e a dose necessária de propofol em exames de endoscopia digestória alta diagnóstica

BACKGROUND AND OBJECTIVES: The introduction of propofol (2,6-diisopropylphenol) as a sedative agent has transformed the area of sedation for endoscopic procedures. However, a major drawback of sedation with the use of propofol is its high incidence of injection pain. The most widely used technique in reducing propofol injection pain is through the association of other drugs. The aim of this study was to evaluate the effect of remifentanil-propofol combination on the incidence of propofol injection pain and its influence on the total dose of propofol required for sedation in upper digestive tract endoscopy (UDE) diagnostic tests. METHOD: One hundred and five patients undergoing upper digestive tract endoscopy were evaluated and randomly divided into 3 groups of 35 patients each. The Control Group received propofol alone; Study-group 1 received remifentanil at a fixed dose of 0.2 mg/kg combined with propofol; Study-group 2 received remifentanil at a fixed dose of 0.3 mg/kg combined with propofol. The incidence of propofol injection pain and the total dose of propofol required for the test were evaluated. The sample was very similar regarding age, weight, height, sex, and physical status. Statistical analysis was performed according to the nature of the evaluated data. Student'st-test was used to compare the mean of age, weight, height (cm), and dose (mg/kg) variables between groups. The χ2 test was used to compare sex, physical status, and propofol injection pain between groups. The significance level was a < 0.05. RESULTS: There was significant statistical difference between the study groups and the control group regarding the parameters of propofol injection pain and total dose of propofol (mg/kg) used. However, there were no statistical differences between the two study groups for these parameters. CONCLUSION: We conclude that the use of remifentanil at doses of 0.2 mg/kg and 0.3 mg/kg was effective for reducing both the propofol injection pain and the total dose of propofol used.

JUSTIFICATIVA E OBJETIVOS: A introdução do propofol (2,6-di-isopropilfenol) como agente sedativo tem transformado a área da sedação para procedimentos endoscópicos. Entretanto, um grande inconveniente da sedação com o uso do propofol é sua alta incidência de dor à injeção. A técnica mais usada na redução da dor à injeção do propofol tem sido a associação com outros fármacos. O objetivo deste estudo foi avaliar a repercussão da associação do remifentanil com o propofol na incidência de dor à injeção de propofol e a influência na dose total de propofol necessária para sedação em endoscopia digestória alta (EDA) diagnóstica. MÉTODO: Foram avaliados 105 pacientes, submetidos à EDA diagnóstica e divididos aleatoriamente em três grupos de 35. O Grupo Controle foi sedado apenas com propofol. O Grupo de Estudo 1 foi sedado com remifentanil em dose fixa de 0,2 µg/kg associado ao propofol. E o Grupo de Estudo 2 foi sedado com remifentanil em dose fixa de 0,3 µg/kg associado ao propofol. Foram avaliadas a incidência de dor à injeção de propofol e a dose de propofol necessária para o exame. A amostra se mostrou bastante similar em relação às variáveis idade, peso, altura, sexo e estado físico. De acordo com a natureza dos dados estudados, procedeu-se ao tratamento estatístico julgado adequado. Usou-se o teste t para comparação, entre os grupos analisados, das médias das variáveis idade, peso, altura (cm) e dose (mg/kg). Foi usado o teste ?2 para comparação, entre os grupos analisados, das variáveis sexo, estado físico e dor à injeção de propofol. O nível de significância adotado foi a < 0,05. RESULTADO: Houve diferença estatística significativa entre os grupos de estudo e o grupo controle tanto no parâmetro dor à injeção de propofol quanto no parâmetro dose de propofol usada (mg/kg). Entretanto, não houve diferenças estatísticas entre os dois grupos de estudo para esses parâmetros. CONCLUSÃO: O uso do remifentanil nas doses de 0,2 µg/kg e de 0,3 µg/kg mostrou-se efetivo tanto sobre o parâmetro redução da dor à injeção de propofol quanto sobre o parâmetro dose de propofol usada.

Relationship of cortisol, norepinephrine, and epinephrine levels with war-induced posttraumatic stress disorder in fathers and their offspring

Objective: To compare afternoon serum/plasma levels of hormones in four groups: (A) veterans with posttraumatic stress disorder (PTSD), (B) offspring of PTSD veterans, (C) veterans without PTSD, and (D) offspring of non-PTSD veterans. Methods: Evaluation consisted of a semi-structured interview for axis I and II diagnoses, followed by measurement of afternoon serum cortisol and plasma epinephrine and norepinephrine by ELISA (Diametra) and LND (LDN Labor Diagnostika Nord GmbH & Co. KG) respectively. Data were analyzed using descriptive statistics and the Student t, Kolmogorov-Smirnov, and nonparametric Mann-Whitney tests. Results: One hundred and sixty-eight volunteers were investigated across the four groups. The groups were similar in terms of demographic characteristics, war experience and traumatization, and psychiatric and medical conditions other than PTSD (group A was similar to group C and group B was similar to group D). Between-groups comparisons did not yield statistically significant differences. Post-hoc analyses revealed significant differences in afternoon cortisol level between the offspring of veterans with current/past history of PTSD and the offspring of veterans without a history of PTSD. Conclusion: We only found decreased cortisol levels in offspring of veterans after rearranging the groups to reflect previous history of PTSD. Further studies are required to investigate the relationship between cortisol levels and the transgenerational effects of trauma and parental PTSD. .

Vitimização secundária nos filhos adultos de veteranos da guerra colonial Portuguesa / Secondary victimization in adult children of Portuguese Colonial War veterans

Este estudo avaliou a vitimização secundária em filhos adultos de veteranos da Guerra Colonial Portuguesa e sua relação com outras variáveis psicológicas. A amostra incluiu 80 filhos. Os instrumentos utilizados foram: Questionário de Vivências Familiares na Infância; Escala de Avaliação Resposta ao Acontecimento Traumático; Questionário de Estilo de Vida e as versões portuguesas do Brief Symptoms Checklist e Health Symptoms Checklist. Os resultados revelaram que 27.5 por cento dos filhos possuíam diagnóstico de Vitimização Secundária (VS) e 66 por cento apresentavam Sintomatologia de Vitimização Secundária (SVS). Esta última encontrava-se positivamente associada à psicopatologia e às vivências familiares negativas na infância. Além disso, os filhos com SVS apresentavam mais sintomas físicos e adotavam menos comportamentos de saúde. Os resultados enfatizam a necessidade de intervenção nesta população.

This study assessed secondary victimization in adult children of Portuguese Colonial War Veterans and its relationship with other psychological variables. The sample included 80 adult children. The instruments used were: Childhood Experiences Questionnaire, Post-Traumatic Stress Scale, Life Style Questionnaire and the Portuguese versions of the Brief Symptoms Checklist and the Health Symptoms Checklist. The results showed that 27.5 percent of the adult children had a secondary victimization diagnosis (SVD) and 66 percent presented Secondary Traumatic Symptoms (STS). The latter was positively associated with psychopathology and to negative family experiences in childhood. In addition, adult children with STS manifested more physical symptoms and less healthy behaviors. The results emphasize the need for intervention in such population.

Efectividad de una intervención cognitivo-conductual para el transtorno por estrés postraumático en excombatientes colombianos / Cognitive behavioral intervention for PTSD in colombian combats veterans

En este estudio se presentan los resultados de las intervenciones grupales cognitivo-comportamentales para el Transtorno de Estrés Postraumático (TEP) realizadas desde el 2002 hasta el 2004, con 42 miembros de las fuerzas armadas colombianas en proceso de rehabilitación

Neuroticismo, extraversión y estilo atribucional en veteranos de guerra: una aproximación desde el estrés postraumático / Neuroticism, extraversion and attributional style in war veterans: A Post-Traumatic Stress Disorder approach

Las personas que experimentan un evento traumático (guerra, desastres naturales, abuso sexual, entre otros), a menudo suelen desarrollar un tipo específico de patología clínica conocida como Síndrome de Estrés Postraumático que frecuentemente está asociada a una serie de trastornos con una fuerte incidencia negativa en la mayoría de los casos, en todos los aspectos de la vida cotidiana de quienes lo padecen. En particular en el caso de los veteranos de la guerra de las Islas Malvinas, que no tuvieron la posibilidad de contar con asistencia psicológica y contención emocional post-guerra, la presencia de este síndrome se encuentra asociada a un estilo atribucional desadaptativo o pesimista, como así también a mayores niveles de neuroticismo y menores de extraversión en comparación con la población general, lo que se traduce en mayores niveles de ansiedad flotante, escasa capacidad de control de los impulsos, inestabilidad emocional e incapacidad para generar y mantener relaciones sociales estables, con respecto a los excombatientes que no desarrollaron estrés postraumático

Mental health in group of war veterans and their spouses in Qom

War is a stressful event that can lead to disastrous situations in human life. Those who are directly involved in this event and influenced by the resulting trauma are the first victims of the war. However the consequences involve the families and the society on the whole. The families of the wounded, disabled, martyred, or imprisoned soldiers are the forgotten victims of wars. The present study was conducted to determine the prevalence of depression and mental disorders in a group of war veterans and their spouses in the Qom province. The study population included 160 males and 90 females, [90 couples]. They were asked to complete two valid questionnaires of Beck and GHQ as well as a questionnaire dealing with their demographic data. Sample selection was random from the official file in the Foundation for the Disabled in the Qom province. 75% of the patients included in the study were unemployed. Beck questionnaire revealed that 96.3% of the ex-soldiers and 88.9% of their spouses were suffering from mild to severe depression. GHQ questionnaire revealed that in 94.5% of veterans and 86.7% of their spouses symptoms suggestive of a mental disorder were present. Anxiety-depression disorders, adjustment disorders and inter-personal relation disorders are common among the ex-servicemen and their spouses. War veterans and their families are in need of better support from different organizations that provide social and health services

Tattoo and Personality Traits in Croatian Veterans

To examine whether tattooed patients, treated for posttraumatic stress disorder (PTSD) caused by war at the Ward for Psycho-trauma of the Clinical Hospital Osijek, differ from non-tattooed patients by certain personality traits. The study was conducted on one hundred Croatian veterans who were divided into two groups with respect to the presence/ absence of tattoo. To assess the symptoms of PTSD, the Clinical Administered PTSD Scale (CAPS-2) was used for all subjects. To assess personality traits the following psychology tests were applied: Purdue non-verbal IQ test, Minnesota Multiphasic Personality Inventory (MMPI-1), and Eysenck's Personality Questionnaire (EPQ/A and EPQ/IVE). With respect to the examined pre-traumatic variables and PTSD symptoms, the two groups manifested no differences. The non-tattooed group achieved higher scores on the IQ test (IQ=100) than the tattooed group (IQ=95). EPQ test showed results either above or below the norms on all scales that were applied. The tattooed group demonstrated significantly higher levels of impulsiveness, adventurism, empathy and neuroticism than the non-tattooed one (p < 0.05). In the group of 100 Croatian veterans treated for PTSD, 33 had tattoos and 67 did not. The results indicated more impulsiveness, adventurism / risk behavior, empathy and neuroticism in the tattooed group than in the non-tattooed group, while there was no significant difference in the intensity of the PTSD symptoms.

Activities of daily functioning and community adjustment of vetereans in the VA residential care program

Este estudio se diseño para identificar el nivel de funcionamiento en actividades del Diario Vivir (ADV) de veteranos colocados en el Programa de Hogares de Cuidado Personal (HCP) del Departamento de Asuntos del Veterano en Puerto Rico. A la vez, se exploró como se relacionaba el ajuste del veterano a la comunidad con su funcionamiento en ADV. Fue un estudio exploratorio, descriptivo de una muestra al azar de 60 veteranos ubicados en 32 hogares. Cada veterano fue evaluado para determinar su nivel de independencia en ADV utilizando un instrumento conocido como Medida de Independencia Funcional (MIF). Se evaluaron los patrones de comportamiento del veterano en el hogar meidante la Escala de Ajuste a la Comunidad. Los hallazgos revelaron que la mayoría de los veteranos del Programa HCP eran ancianos con una edad promedio de 64 años. Funcionaban a un nivel de dependencia modificada en sus ADV. En general, su ajuste a la comunidad fluctuó entre bueno a excelente. No se encontró relación alguna entre el nivel de funcionamiento en ADV y su ajuste a la comunidad