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1.
J. venom. anim. toxins incl. trop. dis ; 28: e20210036, 2022. tab, graf
Article in English | LILACS, VETINDEX | ID: biblio-1356460

ABSTRACT

Background: Scorpions are arachnids that have a generalist diet, which use venom to subdue their prey. The study of their trophic ecology and capture behavior is still limited compared to other organisms, and aspects such as trophic specialization in this group have been little explored. Methods: In order to determine the relationship between feeding behavior and venom toxicity in the scorpion species Tityus fuhrmanni, 33 specimens were offered prey with different morphologies and defense mechanisms: spiders, cockroaches and crickets. In each of the experiments we recorded the following aspects: acceptance rate, immobilization time and the number of capture attempts. The median lethal dose of T. fuhrmanni venom against the three different types of prey was also evaluated. Results: We found that this species does not have a marked difference in acceptance for any of the evaluated prey, but the number of capture attempts of spiders is higher when compared to the other types of prey. The immobilization time is shorter in spiders compared to other prey and the LD50 was higher for cockroaches. Conclusions: These results indicate that T. fuhrmanni is a scorpion with a generalist diet, has a venom with a different potency among prey and is capable of discriminating between prey types and employing distinct strategies to subdue them.(AU)


Subject(s)
Animals , Predatory Behavior , Scorpions , Hunt , Toxicity , Feeding Behavior , Food Chain , Defense Mechanisms , Lethal Dose 50
2.
J. Card. Arrhythm. (Impr.) ; 34(3): 100-104, Dec., 2021.
Article in English | LILACS | ID: biblio-1359636

ABSTRACT

Bidirectional ventricular tachycardia (BDVT) is defined by beat-to-beat alternation of the QRS axis on the electrocardiogram. Its diagnosis is uncommon, and the most characteristic etiology is digitalis intoxication (DI). We report the case of a patient with heart failure of valve origin admitted for sepsis that progressed to BDVT and death, associated with DI.


Subject(s)
Tachycardia, Ventricular , Digoxin , Toxicity
3.
Medicina UPB ; 40(2): 80-83, 13 oct. 2021.
Article in Spanish | LILACS, COLNAL | ID: biblio-1342237

ABSTRACT

El suicidio es un problema de salud pública grave, vincula frecuentemente al consumo de medicamentos. La metformina es un fármaco antihiperglicemiante de fácil acceso y la sobredosis implica riesgos metabólicos, entre ellos, la acidosis láctica es el principal. Teniendo en cuenta la frecuencia de su consumo, es necesario que el personal de salud conozca los riesgos que implica la intoxicación y los signos y síntomas iniciales, pues del manejo adecuado dependerá un pronóstico favorable. El objetivo de este reporte es evidenciar los riesgos metabólicos renales-hemodinámicos, asociados a la toxicidad por metformina, además de resaltar la necesidad de considerar el uso temprano de la terapia de remplazo renal y de concientizar a los clínicos de que exponer a los pacientes a un medicamento, es también exponerlo a efectos adversos o a abuso con fines autolesivos.


Suicide is a serious public health problem that increases worldwide. In Medellín, its incidence is on the rise, and the most frequent mechanism is the ingestion of drugs. Metformin is an antihyperglycemic medication that is easily accessible and frequently used, because it is part of the first line of management of type 2 diabetes mellitus. One of the complications associated with its use is lactic acidosis, which can lead to serious toxicity. Therefore, it is necessary for the health personnel to be aware of the signs and symptoms that can initially appear in the case of intoxication, since a favorable prognosis depends on adequate management. The objective of this report is to present two clinical cases that evidence the wide spectrum of toxicity secondary to the use of metformin and to review the available evidence of the approach to this poisoning, emphasizing the importance of early use of renal replacement therapy.


O suicídio é um grave problema de saúde pública, frequentemente relacionado ao consu-mo de drogas. A metformina é um anti-hiperglicêmico de fácil acesso e a sobredosagem envolve riscos metabólicos, entre eles, a acidose láctica é o principal. Considerando a frequência de seu consumo, é necessário que o pessoal de saúde conheça os riscos das intoxicações e os sinais e sintomas iniciais, pois um prognóstico favorável dependerá de manejo adequado. O objetivo deste relatório é demonstrar os riscos metabólicos renais-hemodinâmicos associados à toxicidade da metformina, além de destacar a necessidade de considerar o uso precoce da terapia de substituição renal e alertar os médicos sobre o que expor os pacientes a um medicamento. a efeitos adversos ou abuso para fins autolesivos.


Subject(s)
Humans , Suicide , Metformin , Acidosis, Lactic , Diabetes Mellitus, Type 2 , Toxicity , Hypoglycemic Agents
4.
Rev. medica electron ; 43(3): 732-749, 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1289815

ABSTRACT

RESUMEN Introducción: en enero de 2000, comenzó la cirugía videolaparoscópica en el Hospital Militar Docente Dr. Mario Muñoz Monroy, de la ciudad de Matanzas. El equipo quirúrgico, en esa época, lo constituían cirujanos con varios años de experiencia y con una sólida formación en cirugía convencional. También poseían habilidades demostradas en la realización de colecistectomía a cielo abierto. A partir de 2011, una nueva generación de cirujanos desarrolló la cirugía mínimamente invasiva, con poca experiencia en cirugía a cielo abierto. Por lo tanto, se presentó la contradicción de que cada vez menos cirujanos tenían la experiencia técnica que requieren los casos más difíciles. Objetivo: determinar la seguridad en la realización de la colecistectomía laparoscópica. Materiales y métodos: Investigación observacional, descriptiva y retrospectiva de los pacientes intervenidos de afecciones biliares benignas, por la técnica de colecistectomía laparoscópica, entre enero de 2014 y diciembre de 2017. Resultados: fueron colecistectomizados 2 016 pacientes. De ellos, 1 759 (87 %) correspondieron al sexo femenino, y 257 (13 %) al masculino. Comorbilidades presentes en el 46,3 %. Cirugías: electivas, 1 801; urgentes, 215. Eventos adversos, 38 (1,88 %). Conversiones, 28 (1,3 %). Mortalidad operatoria, 5 (0,24 %). Conclusiones: resultan seguras las colecistectomías laparoscópicas por el bajo índice de eventos adversos, conversiones y mortalidad operatoria (AU).


ABSTRACT Introduction: video laparoscopic surgery began in January 2000, at the Dr. Mario Muñoz Monroy Military Hospital. The surgical team, at that time, were surgeons with years of experience and a solid training in conventional surgery. They also had demonstrated skills in performing open cholecystectomy. Starting in 2011, a new generation of surgeons developed minimally invasive surgery, with little experience in open surgery. Therefore, it arose the paradox that fewer and fewer surgeons had the technical experience required in the most difficult cases. Objective: to determine the safety in performing laparoscopic cholecystectomy. Materials and methods: retrospective, descriptive and observational research of the patients who underwent surgeries of benign biliary conditions, by the technique of laparoscopic cholecystectomy in the period January 2014- December 2017. Results: 1759 patients were cholecystectomized. 87.25% were female ones and 257 (13%) were male: Comorbidities were present in 46.3%. 1 801 were elective surgeries; emergency surgeries were 215. There were 38 (1.88%) adverse events and 28 (1.3%) conversions. The operatory mortality was 5 (0.24%). Conclusions: laparoscopic cholecystectomy are safe because of the low index of adverse events, conversion and operatory mortality (AU).


Subject(s)
Humans , Male , Female , Cholecystectomy, Laparoscopic/methods , Hospitals, State/methods , General Surgery/methods , Bile Ducts/injuries , Cholecystectomy, Laparoscopic/standards , Toxicity/methods
5.
Rev. Ciênc. Méd. Biol. (Impr.) ; 20(1): 131-136, maio 5, 2021. fi, ilus
Article in Portuguese | LILACS | ID: biblio-1355067

ABSTRACT

Introdução: a Leishmaniose Tegumentar Americana (LTA) é uma infecção zoonótica cujo tratamento é realizado com a droga antimoniato de meglumina (AM). Objetivo: Relatar as alterações eletrocardiográficas decorrentes do uso de AM em pacientes com LTA. Metodologia: foi realizada uma revisão integrativa da literatura por meio das bases de dados BIREME, PUBMED, COCHRANE, SCIELO e literatura cinzenta, usando como estratégia de busca o cruzamento dos seguintes descritores, nos idiomas português e inglês: leishmaniose cutânea, eletrocardiografia, meglumina e toxicidade. Não foi estipulado um intervalo temporal para que um maior número de publicações fosse obtido. Resultados: foram encontrados 134 artigos, desses apenas 09 atenderam aos critérios de inclusão. As principais alterações eletrocardiográficas encontradas durante a terapêutica foram as alterações de repolarização ventricular, com destaque para o prolongamento do intervalo QT corrigido pela frequência cardíaca. Já entre as alterações mais graves em termos de morbimortalidade, destacam-se as arritmias ventriculares complexas, principalmente a Torsade de pointes. Discussão: em todos os artigos selecionados foram encontradas alterações ao eletrocardiograma (ECG) durante o tratamento com AM, sendo recomendado em todos os pacientes, o acompanhamento eletrocardiográfico. Apenas um estudo excluiu as alterações do ECG basal, presença de comorbidades e uso de drogas cardiotóxicas sendo esses possíveis vieses para avaliação da toxicidade cardíaca diretamente provocada pelo antimonial. Conclusão: considerando as alterações na repolarização ventricular e as possíveis arritmias ventriculares em pacientes em tratamento para LTA em uso de AM, o acompanhamento eletrocardiográfico é recomendado durante a terapêutica de todos esses pacientes, sendo útil para prevenção de complicações cardiovasculares importantes.


Introduction: American Tegumentary Leishmaniasis (ATL) is a zoonotic infection whose treatment is carried out with the meglumine antimoniate drug (AM). Objective: To report the electrocardiographic changes resulting from the use of AM in patients with ATL. Methodology: an integrative literature review was carried out using the BIREME, PUBMED, COCHRANE, SCIELO and gray literature databases, using as a search strategy the crossing of the following descriptors, in Portuguese and English: cutaneous leishmaniasis, electrocardiography, meglumine and toxicity. A time interval was not stipulated in order to obtain a greater number of publications. Results: we found 134 articles, of which only 9 met the inclusion criteria. The main electrocardiographic changes found during therapy were changes in ventricular repolarization, with emphasis on the prolongation of the QT interval corrected by heart rate. Already the most serious changes in terms of morbidity and mortality, complex ventricular arrhythmias, especially Torsade de pointes, stand out. Discussion: changes in the electrocardiogram (ECG) were found in all selected articles during treatment with AM, with electrocardiographic monitoring being recommended in all patients. Only one study excluded: changes in the baseline ECG, the presence of comorbidities and / or use of cardiotoxic drugs, these being possible biases to assess cardiac toxicity directly caused by the antimonial. Conclusion: considering the changes in ventricular repolarization and possible ventricular arrhythmias in patients undergoing treatment for ATL using AM, electrocardiographic monitoring is recommended during the therapy of all these patients, being useful for the prevention of important cardiovascular complications.


Subject(s)
Humans , Male , Female , Electrocardiography, Ambulatory , Leishmaniasis, Cutaneous , Toxicity , Meglumine Antimoniate , Review
6.
Braz. dent. sci ; 24(1): 1-9, 2021. tab, ilus
Article in English | LILACS, BBO | ID: biblio-1145441

ABSTRACT

Objective: Unlike traditional composite resins, bulk-fill composite resins could be polymerized as thicker layers. This study aims to contribute to the field by investigating the cytotoxic effects of various bulk-fill composite resins on L929 mouse fibroblast cells in vitro. Material and Methods: In our study, six bulk fill and one conventional composite resin were used. Composite resin samples (8×4 mm) were prepared in a sterile cabinet by using a glass mod and polymerizing with a led light device (DTE LUX E, Germany). Composite samples (n:3) of which surface area was calculated according to ISO 10993-12: 2012 standards (3 cm2/ml), were kept in media for 24 h and 72 h in 37 oC incubator, their extracts were filtered in 1:1 and 1:2 proportion and were added on L929 mouse fibroblast cells. Cell viability was examined by the MTT assay and cell death by the LDH test. Cell viability results were evaluated using one-way analysis of variance (ANOVA) test (p<0.05). Results: When the 1:1 extracts from 4 mm thick bulk-fill composite samples were applied on L929 mouse fibroblast cells, cell viability rates showed significant differences compared to the control group at the end of 24 h and 72 h (except for Estelite Bulk Fill Flow). Although the extracts of the tested composite samples at 1:1 and 1:2 ratio at the end of 72 hours caused a decrease in L929 mouse fibroblast cell viability, the cell viability rate of only PRG-containing bulk fill composite and conventional composite remained below the cell viability ratio (70%) specified in ISO standards. Bulk fill composites did not produce toxic effects (except Beautifil Bulk Restorative) according to the LDH test. Conclusions: Despite decreasing in general the cell viability, bulk-fill composite resins used in 4 mm thick layers provided cell viability rates over the acceptability level, except PRG-containing bulk fill composite (Beautifil Bulk Restorative), which was cytotoxic to L929 mouse fibroblasts. (AU)


Objetivo: Ao contrário das resinas compostas tradicionais, as resinas compostas bulk-fill podem ser polimerizadas como camadas mais espessas. Este estudo visa investigar in vitro os efeitos citotóxicos de várias resinas compostas bulk-fill em células de fibroblastos de camundongo L929.Material e Métodos: Em nosso estudo, seis resinas tipo bulk fill e uma resina composta convencional foram usadas. Amostras de resina composta (8 × 4 mm) foram preparadas em gabinete estéril usando um molde de vidro e polimerizado com um dispositivo de luz LED (DTE LUX E, Alemanha). Amostras compostas (n=3) cuja área de superfície foi calculada de acordo com os padrões ISO 10993-12:2012 (3cm2/ml), foram mantidas em meio e incubadas por 24 h e 72 h a 37 ºC, seus extratos foram filtrados na Proporção de 1:1 e 1:2 e foram acondicionados em cultura de células de fibroblastos de camundongo L929. A viabilidade celular foi examinada pelo ensaio MTT e a morte celular pelo teste LDH. Os resultados de viabilidade celular foram avaliados usando o teste de análise de variância (ANOVA) um fator (p <0,05). Resultados: Quando os extratos foram plaqueados na proporção 1:1 de amostras de compósito bulk-fill de 4 mm de espessura com as células de fibroblastos de camundongo L929, as taxas de viabilidade celular mostraram diferenças significativas em comparação com o grupo controle no final de 24 h e 72 h (exceto para Estelite Bulk Fluxo de enchimento). Embora os extratos das amostras compostas testadas na proporção de 1:1 e 1:2 ao final de 72 horas tenham causado uma diminuição na viabilidade das células de fibroblastos de camundongo L929, a taxa de viabilidade celular apenas do compósito de preenchimento total contendo PRG e o compósito convencional permaneceram abaixo a taxa de viabilidade celular (70%) especificada nas normas ISO. Os compósitos de preenchimento a granel não produziram efeitos tóxicos (exceto Beautifil Bulk Restorative) de acordo com o teste de LDH. Conclusão: Apesar de diminuir em geral a viabilidade celular, as resinas compostas bulk-fill usadas em camadas de 4 mm de espessura forneceram taxas de viabilidade celular acima do nível aceitável, exceto o compósito bulk fill contendo PRG (Beautifil Bulk Restorative), que foi citotóxico para fibroblastos de camundongos L929 (AU)


Subject(s)
Animals , Mice , Composite Resins , Toxicity , Fibroblasts
7.
Med. lab ; 25(1): 363-392, 2021. tab, ilus, graf
Article in Spanish | LILACS | ID: biblio-1292640

ABSTRACT

Las enfermedades pueden generar un desequilibrio de electrolitos como parte de su fisiopatología, al igual que los medicamentos usados crónicamente y algunas sustancias tóxicas disponibles en nuestro medio. A pesar de todos los datos estadísticos existentes, la incidencia global de los trastornos electrolíticos secundarios a fármacos o sustancias tóxicas permanece desconocida, y, posiblemente, subregistrada; por lo tanto, el objetivo de esta revisión es analizar los trastornos electrolíticos que causan algunos medicamentos y sustancias tóxicas, y describir el mecanismo a través del cual se producen las alteraciones, en particular, del sodio, potasio, magnesio, calcio y fósforo, con el fin de alertar a los profesionales de la salud en el momento de enfrentarse a este tipo de condiciones en su práctica clínica. El conocimiento de los efectos adversos relacionados con medicamentos y tóxicos es importante para prevenir, identificar y gestionar de forma eficaz, complicaciones que son potencialmente peligrosas. Esta revisión pretende ser un referente de apoyo para los profesionales de la salud en estas situaciones


Diseases can generate an electrolyte imbalance as part of their pathophysiology, as well as chronic use of some medications, and toxic substances available in our environment. Despite all the separate statistical data, the overall incidence of fluid and electrolyte disorders secondary to drugs or toxic substances remains unknown, and possibly underreported; therefore, the objective of this review is to analyze electrolyte disorders caused by some medications and toxic substances, and describe the mechanism through which changes in sodium, potassium, magnesium, calcium and phosphorus occur, in particular, in order to alert health professionals when facing this type of conditions in their clinical practice. Knowledge of drug and toxic-related adverse effects is important to effectively prevent, identify, and manage complications that can be potentially life-threatening. This review intends to be a reference for supporting health professionals in these situations


Subject(s)
Electrolytes , Pharmaceutical Preparations , Sodium-Potassium-Exchanging ATPase , Diuretics , Ethanol , Toxicity
8.
Arq. Inst. Biol ; 88: e00622019, 2021. graf
Article in English | LILACS, VETINDEX | ID: biblio-1146670

ABSTRACT

Aristolochia plants are notable from an ethnopharmacological viewpoint, but the relevance of these species for medicinal purposes has been debated because of their inherent toxicity. The convergence of these contrasting realities can be readily achieved using bioconversion methods, which have been shown to be useful tools for numerous applications, including the detoxification of biomass. In this context, methanolic extracts of leaves from Aristolochia triangularis and Aristolochia gibertii, as well as the feces of Battus polydamas larvae fed with leaves from these plants, were prepared, and their cytotoxic activities were evaluated on a human fibroblast cell line (GM07492). The leaf extracts were found to be cytotoxic, leading to reductions of 42.1 and 33.8% on cell viability, respectively, while the fecal extracts were considered inactive. In addition to evidencing the cytotoxicity of A. triangularis and A. gibertii, these findings demonstrated a potential bioconversion strategy for obtaining aristolochiaceous extracts with reduced toxicity using the larvae of a specialist phytophagous insect, thus renewing expectations in relation to the pharmacological importance of Aristolochia spp. The results were also ecologically relevant, as B. polydamas larvae were found to be able to detoxify compounds from host plants.(AU)


Subject(s)
Biodegradation, Environmental , Aristolochiaceae , Toxicity , Cell Line , Fibroblasts , Insecta , Larva
9.
Pesqui. vet. bras ; 41: e06921, 2021. tab
Article in English | LILACS, VETINDEX | ID: biblio-1287506

ABSTRACT

Plants of the genus Brachiaria, used in several countries as forage, are poisonous to some livestock species. Their toxic principle is protodioscin, and the main form of clinical presentation of the toxicosis is hepatogenous photosensitization. Here we compare protodioscin levels in B. decumbens and B. brizantha and review the literature on the concentrations and methodologies of collection and analysis of the toxic principle in Brachiaria spp. and the risk of contamination of pastures by more toxic species that may facilitate poisoning by plants of this genus in sheep. The experiment was conducted in pastures originally formed by B. brizantha, with many B. decumbens invasion points. The occurrence of cases of poisoning by Brachiaria spp. was the criterion for confirming pasture toxicity. The forage samples were collected at ten random points every 28 days through manual grazing simulation. The samples were analyzed for protodioscin by high-performance liquid chromatography (HPLC) with light scattering by evaporation (ELSD) after being dried and crushed. In the flock of 69 sheep, five poisoning cases occurred, three sheep died, and two recovered. The protodioscin levels found in the evaluated pastures ranged from 0.70 to 0.45%; higher levels appeared in B. decumbens (7.09%) compared to 1.04% in B. brizantha. We suggest that Brachiaria spp. should be avoided in pastures where sheep are grazing.(AU)


Plantas do gênero Brachiaria, utilizadas em vários países como forragem, são tóxicas para várias espécies pecuárias. Seu princípio tóxico é a protodioscina, e a principal forma de apresentação clínica da toxicose é a fotossensibilização hepatógena. Este estudo teve como objetivo comparar os níveis de protodioscina em B. decumbens e B. brizantha e revisar a literatura sobre as concentrações e metodologias de coleta e análise do princípio tóxico em Brachiaria spp. e o risco de contaminação das pastagens por espécies mais tóxicas que podem facilitar a intoxicação por plantas desse gênero em ovinos. O experimento foi conduzido em pastagens originalmente formadas por B. brizantha, com diversos pontos de invasão por B. decumbens. Ocorrência de casos de intoxicação por Brachiaria spp. foi o critério para confirmação da toxicidade da pastagem. As amostras de forragem foram coletadas a cada 28 dias em dez pontos aleatórios por meio de simulação de pastejo manual. As amostras foram analisadas para protodioscina por cromatografia líquida de alta eficiência (HPLC) com dispersão de luz por evaporação (ELSD) após serem secadas e trituradas. No rebanho de 69 ovelhas, cinco desenvolveram a intoxicação, três morreram e duas se recuperaram. Os níveis de protodioscina encontrados nas pastagens avaliadas variaram de 0,70 a 0,45%; níveis mais elevados apareceram em B. decumbens (7,09%) em comparação com 1,04% em B. brizantha. Sugerimos que Brachiaria spp. deve ser evitada no pasto de ovelhas em pastejo.(AU)


Subject(s)
Animals , Plant Poisoning , Ruminants , Sheep , Pasture , Brachiaria , Photosensitivity Disorders , Toxicity , Literature
10.
Repert. med. cir ; 30(2): 101-108, 2021. tab.
Article in English, Spanish | LILACS, COLNAL | ID: biblio-1361819

ABSTRACT

Antecedentes: en los últimos 40 años el cambio en las prácticas agrícolas ha llevado al consecuente uso de plaguicidas con el fin de incrementar las cosechas y evitar plagas que afecten la producción, siendo un procedimiento usual a nivel mundial. En Colombia la utilización de estos plaguicidas en especial el glifosato, cuya marca comercial a nivel mundial se conoce como Roundup®, compuesto por 480 g/L de la sal isopropilamina de N-fosfonometilglicina, es ampliamente empleado desde hace más de 30 años sobre todo en el Valle del Cauca donde se utiliza para la maduración de la caña de azúcar y como herbicida para cultivos de café, banano, arroz, cacao y palma africana así como cítricos en otras regiones del país. Métodos:se realizó una búsqueda sistemática e integral de la literatura en las bases de datos Cochrane, Medline, Embase, Lilacs y Scielo utilizando diferentes combinaciones de exposición y términos de resultado. Resultados: la búsqueda encontró trece estudios que prueban asociaciones entre glifosato y defectos de nacimiento. Conclusiones: en cinco de los trece no se encontró asociación entre la exposición al glifosato y la presentación de malformaciones, mientras que en ocho artículos hubo algún tipo de asociación entre la presencia de malformaciones y el contacto con glifosato o sus sales. Se hace necesario realizar estudios prospectivos.


Background: in the last 40 years, changes in agricultural practices have led to the consequent use of pesticides to increase yields and avoid pests that affect production, being a procedure commonly used worldwide. In Colombia, the use of these pesticides, especially glyphosate, whose worldwide trade name is Roundup®, composed of 480 g/L of the isopropylamine salt of N-phosphonomethylglicine, has been extensively used for more than 30 years in the Valle del Cauca region to accelerate ripening of sugar cane, and applied as a herbicide for coffee, banana, rice, cocoa and African palm crops, as well as in citrus groves, in other regions of the country. Methods: a systematic and comprehensive literature search was performed in Cochrane, Medline, Embase, Lilacs and Scielo databases using different combinations of exposure and outcome terms. Results: the search found thirteen studies testing associations between glyphosate and birth defects. Conclusions: five of the thirteen articles found no association between glyphosate exposure and the occurrence of malformations, while eight studies found some type of association between malformations and contact with glyphosate or its salts. Further prospective studies are needed.


Subject(s)
Congenital Abnormalities , Toxicity , Herbicides , Prospective Studies , Risk Factors
11.
REVISA (Online) ; 10(2): 224-228, 2021.
Article in Portuguese | LILACS | ID: biblio-1178421

ABSTRACT

Objetivo: Relatar a assistência de enfermagem diante do caso de um adolescente com diagnóstico de Necrólise Epidérmica Tóxica (NET) internado em uma Unidade de Terapia Intensiva de Queimados. Método: Trata-se de um relato de caso sobre as intervenções de enfermagem realizadas em um adolescente com diagnóstico de NET, internado por um mês em 2020 na Unidade de Terapia Intensiva de Queimados de Goiás. As informações foram coletadas do prontuário do paciente. Resultados: Apresentamos práticas clínicas para auxiliar no manejo de pacientes com NET. O caso apresentado teve um desfecho positivo. Conclusão: Os cuidados de enfermagem são essenciais para o prognóstico positivo do paciente. Nesse caso, a enfermagem atuava principalmente no cuidado de feridas, administração de medicamentos, laserterapia e vigilância para prevenção de infecções


Objective: To report nursing care facing a case of an adolescent diagnosed with Toxic Epidermal Necrolysis (TEN) hospitalized in a Burns Intensive Care Unit. Method: This is a case report on the nursing interventions performed on a teenager diagnosed with TEN, who was hospitalized for a month in 2020 at the Burn Intensive Care Unit in the state of Goiás. The information was collected from the patient's medical record. Results: We present clinical practices to assist the management of patients with TEN. The case presented had a positive outcome. Conclusion: Nursing care is essential for the positive prognosis of the patient. In this case, nursing acted mainly in wound care, medication administration, laser therapy and surveillance to prevent infections


Objetivo: Informar los cuidados de enfermería en el caso de un adolescente diagnosticado de Necrólisis Epidérmica Tóxica (TNE) ingresado en una Unidad de Cuidados Intensivos por Quemados. Método: Se trata de un relato de caso sobre las intervenciones de enfermería prestadas a un adolescente diagnosticado de TNE, hospitalizado durante un mes en 2020 en la Unidad de Cuidados Intensivos Quemados de Goiás, información obtenida de la história clínica del paciente. Resultados: Presentamos prácticas clínicas para ayudar en el manejo de pacientes con TNE. El caso presentado tuvo un resultado positivo. Conclusión: El cuidado de enfermería es fundamental para el pronóstico positivo del paciente. En este caso, la enfermería trabajó principalmente en el cuidado de heridas, administración de medicamentos, terapia con láser y vigilancia para prevenir infecciones.


Subject(s)
Humans , Skin , Necrosis , Nursing Care , Wounds and Injuries , Burns , Adolescent , Toxicity , Lasers
12.
Diaeta (B. Aires) ; 38(173): 38-48, dic. 2020. graf
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1278981

ABSTRACT

Resumen Introducción. El Zinc (Zn) es un oligoelemento esencial con gran importancia nutricional e indispensable para el crecimiento normal y la reproducción. Su deficiencia produce anormalidades fisiológicas y estructurales. Así mismo, ingerido en altas concentraciones produce efectos tóxicos, de allí la importancia de su determinación. El agua puede contribuir significativamente a la ingesta diaria de elementos trazas, entre ellos Zn. En el presente estudio se analizó el aporte de Zn en muestras de aguas de ríos y de red (de suministro público) de la provincia de San Luis y en agua mineral natural envasada, por medio de fluorescencia en fase sólida (FFS). Materiales y método.La determinación cuantitativa de Zn en muestras de agua y estándares se basó en la complejación del Zn utilizando una mezcla de o-fenantrolina y eosina a pH 7,5. Luego, una microzona de papel de filtro Blue Ribbon se impregna con la mezcla durante 1 minuto (n=6). Posteriormente, los papeles de filtro se secaron a temperatura ambiente y se colocan en una celda de cuarzo convencional adaptada para FFS. Los resultados obtenidos fueron comparados con la técnica de espectrometría de masas con plasma acoplado inductivamente. Resultados. Las muestras de agua de río analizadas presentaron valores por debajo del límite máximo de Zn recomendado por la Ley Nacional 24051, para la protección de la vida acuática. Las concentraciones de Zn en las muestras de agua de consumo analizadas (de red y envasadas) también estuvieron por debajo de los límites máximos permitidos por el Código Alimentario Argentino y la OMS. Por otro lado, se obtuvo buena concordancia entre las metodologías utilizadas. Conclusiones. El contenido de Zn de las muestras analizadas se encuentra por debajo de los valores máximos permitidos por los distintos organismos de regulación. Las muestras de agua analizadas no contribuyen a satisfacer la ingesta diaria recomendada y presentan valores considerablemente menores a los encontrados en otras regiones. Finalmente, el método aplicado mostró ser una alternativa rápida y sensible para la determinación de Zn en muestras de agua.


Abstract Introduction. Zinc (Zn) is an essential trace element with great nutritional importance and indispensable for normal growth and reproduction. Its deficiency produces physiological and structural abnormalities. Also, if ingested in high concentrations, it produces toxic effects; this is why its determination is very important. Water can contribute significantly to the daily intake of trace elements, including Zn. In this work, Zn concentration was analyzed in river and tap water samples of the province of San Luis and in bottled natural mineral water, by means of solid phase fluorescence (SPF). Materials and method. The quantitative determination of Zn in water samples and standards was based on the complexation of Zn using a mixture of o-phenanthroline and eosin at pH 7.5. Then, a microzone of Blue Ribbon filter paper was impregnated with the mixture for 1 minute (n=6). After this, the filter papers were dried at room temperature and placed in a conventional quartz cell adapted for SPF. The results obtained were compared with the Inductively Coupled Plasma - Mass Spectrometry (ICP-MS) technique. Results. The river water samples analyzed were found below the maximum limit of Zn recommended by National Law 24051 for the protection of aquatic life. The Zn concentrations in the analyzed drinking water samples (tap and bottled water) were also below the maximum limits allowed by the CAA and WHO. Furthermore, a good agreement was obtained between the methodologies used. Conclusions. The Zn content in analyzed samples was below the maximum values allowed by different regulatory organizations. The water samples analyzed do not contribute to satisfying the recommended daily intake and have considerably lower values than those found in other regions. Finally, the method applied proved to be a fast and sensitive alternative for the determination of Zn in water samples.


Subject(s)
Zinc , Drinking Water , Elements , Toxicity
13.
Rev. med. Risaralda ; 26(2): 166-171, jul.-dic. 2020. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1150026

ABSTRACT

Abstract Introduction: Sodium fluoroacetate, known as compound 1080, was discovered in Germany during the Second World War. It is usually used as a rodenticide, it is an odorless and tasteless substance, with a lethal dose in humans of 2 mg / kg that is why it was withdrawn from the market in some countries, including Colombia; however, it is obtained illegally. This substance has biochemical and physiological effects at the cellular level that alter the transport of citrate at the mitochondrial level, generating accumulation of lactic acid and alteration of the glucose use. The clinical manifestations are nonspecific since there is no any cardinal symptom. Therefore, its diagnosis is made due to high clinical suspicion associated with establishment of exposure to the compound in view of the difficulty to obtain paraclinical confirmation in a timely manner. Methods: We present a case report of intentional ingestion of sodium fluoroacetate in an adolescent that is associated with an infection added to the bloodstream by methicillin- sensitive Staphylococcus aureus (MSSA). The patient developed multiple complications that lead to support in the Intensive Care Unit (ICU) with a satisfactory outcome. In view of the lack of a specific antidote, she was treated with ethanol in order to increase the level of acetate; thus, offering an alternative substrate to the Krebs cycle. It is suggested that the ethanol offers benefits in the acute treatment of these patients. Results: The patient with sodium fluoroacetate poisoning and kidney failure received renal replacement therapy with a favorable evolution and survival at discharge from the intensive care unit of a third-level hospital in the city of Pereira, Risaralda, Colombia. Conclusions: Sodium fluoroacetate poisoning is relatively rare and can cause acute kidney injury and multi-organ failure with a high rate of complications and death. A case of self-inflicted poisoning that received a timely manner continuous renal replacement therapy with a favorable outcome in terms of ICU survival was presented.


Resumen Introducción: El fluoroacetato de sodio ⎯conocido como compuesto 1080⎯, fue descubierto en Alemania durante la segunda guerra mundial, suele ser utilizado como raticida y se caracteriza por ser una sustancia inodora e insabora. En humanos, una dosis de 2 a mg/kg es letal; debido a su toxicidad fue retirado del mercado en algunos países, incluyendo Colombia, no obstante, se consigue de forma ilegal. Esta sustancia tiene efectos bioquímicos y fisiológicos a nivel celular que altera el transporte del citrato a nivel mitocondrial, generando acumulación de ácido láctico y alteración en la utilización de la glucosa. Las manifestaciones clínicas son inespecíficas y no existe un síntoma cardinal. Por ende, su diagnóstico se realiza por alta sospecha clínica, asociado al establecimiento de la exposición al compuesto, ya que la confirmación paraclínica es difícil de realizar oportunamente. Métodos: Se presenta un reporte de caso de ingestión intencional en un adolescente, asociado con infección agregada al torrente sanguíneo por Estafilococos Aureos Meticilino Sensible (EAMS). El paciente desarrolló múltiples complicaciones y requirió asistencia en Unidad de Cuidados Intensivos (UCI) con desenlace satisfactorio. Ya que no se cuenta con antídoto específico , se le dio tratamiento con etanol para aumentar el nivel de acetato, ofreciendo así un sustrato alterno al ciclo de Krebm. Se estima que el etanol puede ofrecer beneficios en el tratamiento agudo de estos pacientes. Resultados: Paciente con intoxicación por fluoroacetato de sodio e insuficiencia renal, recibe terapia de reemplazo renal con un evolución favorable y supervivencia al alta de la Unidad de Cuidados Intensivos de un hospital de tercer nivel en la ciudad de Pereira, Risaralda, Colombia. Conclusiones: La intoxicación por fluoroacetato de sodio es relativamente poco frecuente y puede causar injuria renal aguda y falla multiorgánica con alta tasa de complicaciones y muerte. Se presentó un caso de intoxicación autoinfligida que recibió terapia de reemplazo renal continua temprana con un desenlace favorable en términos de supervivencia en la UCI.


Subject(s)
Humans , Male , Adolescent , Staphylococcus aureus , Toxicity , Fluoroacetates , Methicillin , Acetates , Rodenticides , Citric Acid Cycle , Citric Acid , Lactic Acid , Diagnosis , Ethanol , Eating , Acute Kidney Injury , Hoarding , Survivorship , Continuous Renal Replacement Therapy , Glucose , Hospitals , Intensive Care Units , Lead
14.
Int. j. odontostomatol. (Print) ; 14(4): 572-574, dic. 2020. graf
Article in Spanish | LILACS | ID: biblio-1134540

ABSTRACT

RESUMEN: Las úlceras orales (UO) son uno de los signos de toxicidad por metotrexato (Mtx) aún en pacientes con esquemas de dosis bajas para el control de artritis reumatoide (AR). En estos casos establecer un diagnóstico correlacionando UO con el medicamento puede ser un reto. Presentamos 2 casos clínicos de pacientes con AR en tratamiento con Mtx, las cuales desarrollaron UO. En los dos casos, interesantemente los pacientes fueron evaluados tanto por especialistas del área médica y oral sin tener un resultado satisfactorio después de múltiples tratamientos. Las UO resolvieron posterior a la suspensión del medicamento. Se estableció el diagnóstico de Estomatitis por Metotrexato (EMtx) por un especialista en medicina oral. El manejo multidisciplinario en estos casos es clave para el establecimiento de un diagnóstico y tratamiento oportuno.


ABSTRACT: Oral ulcers (OU) are a sign of methotrexate (Mtx) toxicity, even in patients with rheumatoid arthritis (RA) that are under a low-dose regime. In those cases, establishing a diagnosis correlating OU with the medication can be quite a challenge. Here we present 2 clinical cases of RA patients under Mtx treatment that developed OU. Interestingly, in both cases the patients were evaluated by two specialists in the medical and dentistry area, and following multiple treatments there was no satisfactory result. However, oral ulcers resolved after stopping the treatment. A diagnosis of Metotrexato stomatitis was established (SMtx) by a specialist in oral medicine. Multidisciplinary management in these cases is key for the establishment of an opportune diagnosis and treatment.


Subject(s)
Humans , Female , Aged , Stomatitis, Aphthous/diagnosis , Methotrexate/adverse effects , Oral Ulcer/diagnosis , Oral Ulcer/therapy , Arthritis, Rheumatoid , Oral Ulcer/complications , Oral Ulcer/chemically induced , Toxicity
15.
Rev. colomb. anestesiol ; 48(3): 169-173, July-Sept. 2020. graf
Article in English | LILACS, COLNAL | ID: biblio-1126299

ABSTRACT

Abstract Introduction: Regional anesthesia is widely used for postopera tive analgesia in total knee arthroplasty (TKA). Although it is a safe and effective procedure, serious complications may still develop. In the event of an unusual or torpid evolution, the possibility of local anesthetic-induced myotoxicity should be suspected. Case presentation: A 54-year old patient, American Society of Anesthesiologists (ASA) II, underwent TKA due to primary gonarthrosis.. The analgesic technique used was a femoral nerve block associated with continuous perineural infusion. 24 hours later, the patient's medical condition deteriorated presenting pain, edema, and functional limitation of the thigh of the operated extremity. The symptoms were suggestive of myotoxicity, confirmed with diagnostic images leading to the removal of the catheter. The patient experienced then a significant improvement and was discharged 5 days after surgery. Conclusion: The diagnosis of myotoxicity from local anes thetics is rare, since its manifestations may be masked by the usual symptoms of the postoperative period. Early identification of the condition is fundamental to reduce its negative impact on the patient's recovery and satisfaction. Since the scope of the damage depends particularly on the concentration and duration of the exposure to the local anesthetic agent, there is a need to implement protocols that enable an effective block with the lowest concentration and volume of the medication.


Resumen Introducción: La anestesia regional es ampliamente usada para la analgesia posoperatoria en la Artroplastia de Reemplazo de Rodilla (ARR). Aunque son procedimientos seguros y efectivos, la posibilidad de complicaciones graves existe. Ante una evolución inusual o tórpida se debe sospechar la posibilidad de miotoxicidad inducida por anestésicos locales. Presentación del caso: En un paciente de 54 años, American Society of Anesthesiologists (ASA) II, se llevó a cabo ARR por gonartrosis primaria. Como técnica analgésica se usó el bloqueo de nervio femoral asociado a infusión continua perineural. 24 horas después el paciente presenta deterioro clínico dado por dolor, edema y limitación funcional en muslo de extremidad operada. Ante síntomas sugestivos de miotoxicidad confirmada por imágenes diagnósticas, el catéter fue retirado. Posteriormente, presentó una mejoría significa tiva y egresó del hospital al quinto día posoperatorio. Conclusiones: El diagnóstico de miotoxicidad por anestésicos locales es poco frecuente debido a que sus manifestaciones pueden estar enmascaradas por los síntomas habituales durante el periodo posoperatorio. Su identificación temprana es funda mental para disminuir el efecto negativo sobre la recuperación y la satisfacción del paciente. Dado que la magnitud del daño depende especialmente de la concentración y la duración de la exposición al anestésico local, es necesario implementar proto colos que permitan lograr un bloqueo efectivo con la menor concentración y volumen posible del medicamento.


Subject(s)
Humans , Male , Middle Aged , Arthroplasty , Bupivacaine , Myotoxicity , Analgesia , Surgical Procedures, Operative , Toxicity
16.
Rev. Ciênc. Méd. Biol. (Impr.) ; 19(1): 54-57, jun 17, 2020.
Article in English | LILACS | ID: biblio-1358670

ABSTRACT

Introduction: the toxicity of pesticides on bacterial cell growth is still limited. Objectives: The current study aimed to assess the in vitro growth rate of the C. violaceum wild type strain ATCC12472 exposed to the herbicide paraquat dichloride hydrate at different incubation times and final concentrations. Methodology: bacterial inocula were incubated in a nutrient broth medium containing the compound paraquat at final concentrations 100 and 1.000 µg mL-1 under aeration conditions. Spectrophotometric readings at different incubation times were carried out to estimate the in vitro bacterial growth rate. Moreover, the number of viable bacteria cells in the samples was also estimated in the presence of the paraquat at two concentrations tested based on colony-forming units grown on the nutrient broth agar. Results: significant decreases in the C. violaceum growth rate were detected, after one hour of paraquat exposure at a final concentration of 1,000 µg mL-1 (p<0.05) compared to all treatments tested. After two hours of paraquat exposure, significant decreases were progressively found at all final concentrations of 100 (p<0.01) and of 1,000 µg mL-1 (p<0.001). These data were also corroborated by counting the total number of colony-forming units at final concentrations tested. Conclusion: the findings described in current study suggest that the compound paraquat dichloride hydrate exerts significant effects on the in vitro growth rate of a C. violaceum wild type strain.


Introdução: a toxicidade de pesticidas sobre o crescimento de células bacterianas ainda é limitada. Objetivos: o presente estudo objetivou avaliar a taxa de crescimento in vitro de uma cepa selvagem de C. vilaceum ATCC12472 exposta ao herbicida hidratodicloreto de paraquat em diferentes tempos de incubação e concentrações finais. Metodologia: inóculos bacterianos foram incubados em um caldo nutritivo contendo o composto paraquat nas concentrações 100 e 1.000 µg mL-1 sob condições de aeração. Leituras espectrofotométricas em diferentes tempos de incubação foram realizadas para estimar a taxa de crescimento in vitro bacteriano. Além disso, o número de células bacterianas viáveis nas amostras foi também estimado na presença do paraquat nas duas concentrações testadas, baseado no número de unidades formadoras de colônias crescidas em meio nutritivo ágar. Resultados: diminuições significativas na taxa de crescimento da C. violaceum foram detectadas, após uma hora de exposição ao paraquat na concentração final de 1.000 µg mL-1 (p<0,05) em comparação aos demais tratamentos testados. Com duas horas de exposição ao paraquat, diminuições significativas foram progressivamente encontradas em todas as concentrações finais de 100 (p<0,01) e de 1.000 µg mL-1 (p<0,001). Tais dados foram corroborados pela contagem do número total de unidades formadoras de colônias nas concentrações analisadas. Conclusão: as descobertas descritas aqui sugerem que o composto hidrato-dicloreto de paraquat exerce efeitos significativos sobre a taxa de crescimento in vitro de uma cepa selvagem da bactéria C. violaceum


Subject(s)
Poisoning , Bacteria , Ecosystem , Toxicity
17.
Biosci. j. (Online) ; 36(3): 702-712, 01-05-2020. tab, graf
Article in English | LILACS | ID: biblio-1146497

ABSTRACT

The aluminum in high levels in the soil affects the emergence, growth, and development of various species. Therefore, the objective of this study was to evaluate the emergence and physiological behavior of four provenances of Jatropha curcas subjected to different levels of aluminum. The experiment was performed in a greenhouse in a completely randomized design, with four levels of aluminum in the soil (8.2, 16.5, 24.0 mmolc·dm-3 and control) and four provenances of J. curcas seeds (P1 = Dourados-MS, P2 = Montes Claros-MG, P3 = Alta Floresta-MT, and P4 = Petrolina-PE); the effects of aluminum toxicity were investigated in 25, 50, 75, and 100 days after emergence. The levels of aluminum in the soil were collected from the initial soil correction, which featured an aluminum level of 24.0 mmolc dm-3. The seedling emergence was not affected by treatment with aluminum; however, the height and leaf area of P1, P2, and P3 were reduced with increasing levels of aluminum. The emergence and vigor of J. curcas seeds were not influenced by the differences in the origins of the seeds or by the aluminum levels evaluated. Gas exchanges were affected negatively by aluminum and the responses of the chlorophyll a fluorescence indicate harmful effect in the photosynthetic apparatus. The seeds of origin P4 (Petrolina-PE) has increased tolerance to stress conditions.


O alumínio em níveis elevados no solo afeta a emergência, o crescimento e o desenvolvimento de diversas espécies. Diante disso, o objetivo desse trabalho foi avaliar a emergência e o comportamento fisiológico de quatro procedências de Jatropha curcas submetidas a diferentes níveis de alumínio. O experimento foi conduzido em casa de vegetação, em delineamento inteiramente casualizado, com quatro níveis de alumínio no solo (8,2; 16,5 e 24,0 mmolc dm-3 e o controle) e quatro procedências de sementes de J. curcas (P1 = Dourados-MS P2 = Montes Claros-MG, P3 = Alta Floresta-MT e P4 = Petrolina-PE), e os efeitos da toxicidade do alumínio foram investigados aos 25, 50, 75 e 100 dias após a emergência. A emergência das plântulas não foi afetada pelo tratamento com alumínio; no entanto, a altura e a área foliar de P1, P2 e P3 foram reduzidas com níveis crescentes de alumínio. A emergência e o vigor das plântulas das procedências não foram afetados pelos níveis de alumínio avaliados. A taxa fotossintética, taxa de transpiração e condutância estomática também foram reduzidas quando as plantas foram cultivadas em solo contendo altas níveis de alumínio. As plantas P4 foram menos sensíveis aos níveis crescentes de alumínio.


Subject(s)
Soil , Jatropha , Aluminum , Photosynthesis , Soil Analysis , Growth and Development , Control , Toxicity , Chlorophyll A
18.
Con-ciencia (La Paz) ; 8(1): 79-97, 20200400. ilus.
Article in Spanish | LILACS, LIBOCS | ID: biblio-1178614

ABSTRACT

OBJETIVOS: contribuir con una revisión bibliográfica acerca de la acción del dióxido de cloro sobre ciertos microorganismos y biomoléculas. Hacer una revisión de sus usos, toxicidad, reactividad química y bioquímica además de los estudios llevados adelante en modelos animales. Entender cuál es el alcance de los estudios en modelos animales y relacionarlos con la posibilidad de realizar estudios en humanos. METODOLOGÍA: se realizó una revisión exhaustiva sobre el dióxido de cloro. Su uso como antiséptico, toxicidad, estructura molecular, generación de oxígeno molecular, reactividad con biomoléculas y experimentos en modelos animales para entender cuál es el estado del arte de las investigaciones sobre esta molécula. Todas las búsquedas fueron realizadas en bases de datos de artículos científicos así como también por intercambio de información con profesionales entendidos en el tema y curiosidades del colectivo popular. RESULTADOS: la estructura y reactividad molecular del dióxido de cloro determinan una reactividad alta con ciertos aminoácidos y proteínas, explicando así su actividad biológica inhibitoria. Varios estudios demostraron esta actividad inhibitoria frente a diferentes microorganismos, incluyendo los virus. Tales datos y un ensayo clínico en humanos determinaron una baja toxicidad a bajas concentraciones. Sin embargo, pese a tales evidencias, la falta de más estudios clínicos en situaciones controladas inviabiliza la posibilidad de extrapolar los datos al ser humano para mitigar enfermedades infecciosas como el Covid-19. CONCLUSIONES: la reactividad del dióxido de cloro queda clara y su acción sobre las proteínas explica su efectiva acción contra microorganismos como los virus. Su baja toxicidad en estudios llevados adelante en modelos animales abre la posibilidad de más estudios clínicos. Extrapolar los datos que se tienen hasta ahora al ser humano no es correcto.


OBJECTIVES: to contribute with a bibliographic review about the action of chlorine dioxide on certain microorganisms and biomolecules. To review its uses, toxicity, chemical and biochemical reactivity besides studies carried out in animal models. To understand what the extent of the studies in animal models is and relate them with the possibility of carrying out studies in humans. METHODOLOGY: an exhaustive review has been done about chlorine dioxide. Its use as an antiseptic, toxicity, molecular structure, molecular oxygen generation, reactivity with biomolecules and experiments on animal models to understand at which state of the art the research on this molecule is. Every search was carried out in data bases of scientific papers as well as by information exchange with professionals of the field and certain curiosities of the popular collective. RESULTS: The structure and molecular reactivity of chlorine dioxide determines a high reactivity with certain aminoacids and proteins, therefore explaining its inhibitory biological activity. Several studies demonstrated this inhibitory activity against different microorganisms, including viruses. These data and a clinical assay in humans determined a low toxicity at low concentrations. Nonetheless, the lack of more human clinical studies in controlled situations prevents it from the possibility to extrapolate those data to human beings in order to mitigate infectious diseases like Covid-19. CONCLUSIONS: the reactivity of chlorine dioxide remains clarified and its action on proteins explains the effective action against microorganisms like viruses. Its low toxicity in studies carried out in animal models opens the possibility of more clinical studies. Extrapolate data obtained so far to human beings is not correct.


Subject(s)
Unified Health System , Chlorine Dioxide , Amino Acids , Review Literature as Topic , Coronavirus Infections , Toxicity
19.
Rev. colomb. cancerol ; 24(1): 3-10, ene.-mar. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1115578

ABSTRACT

Resumen Objetivo: El uso de medicamentos en condiciones diferentes a las autorizadas es el uso de medicamentos en condiciones distintas a las incluidas en su ficha técnica. El objetivo del presente trabajo es analizar las solicitudes de medicamentos fuera de ficha técnica y sus resultados, realizadas por el Servicio de Oncología y Hematología en un hospital de segundo nivel. Materiales y métodos: Se realiza un estudio observacional retrospectivo de todas las peticiones de fármacos "off label" recibidas por el Servicio de Farmacia. Los medicamentos se clasifican según impacto económico, una clasificación propia según el tipo de fármaco y motivo de petición y según su grado de evidencia. Se analiza para cada solicitud los datos demográficos, de diagnóstico y de tratamiento de los pacientes. Se presenta un seguimiento de los efectos adversos, mediana de supervivencia libre de progresión y mediana de supervivencia global. Resultados: Se aprueban 85 solicitudes de tratamiento. La mayoría de los tratamientos son de alto impacto dirigidos principalmente a patologías raras y últimas opciones de tratamiento. Un 22% de las solicitudes presentan alto grado de evidencia. La media de supervivencia libre de progresión (SLP) es de 6,6 meses (IC 95% 5,2-8) y la supervivencia global (SG) es de 9,7 meses (IC95% 8,2-11,2). Un 18,7% de pacientes presentan toxicidad de grado 3-4 al recibir el tratamiento. Conclusiones: A pesar de la heterogeneidad de las patologías, y la baja evidencia, los resultados obtenidos en SLP y SG, junto a la escasa toxicidad obliga a seguir avanzando en la evaluación de este tipo de tratamientos.


Abstract Background and objective: the use of off-label drugs is the use of medications in conditions other than those included in its prescribing information. The objective of this paper is to analyze the off-label drugs applications and their results, performed by the Oncology and Hematology services in a second level hospital. Materials and methods: A retrospective observational study of all requests for "off label" drugs received by the Pharmacy Service is carried out. The drugs are classified according to economic impact, a classification according to the type of drug and the reason for the request and according to the degree of evidence. The demographic, diagnostic and treatment data of the patients are analyzed for each request. A follow-up of adverse effects, median progression-free survival and median overall survival is presented. Results: 85 treatment requests are approved. Most of the treatments are high impact, mainly aimed at rare pathologies and last treatment options. 22% of the requests have a high degree of evidence. Progression free survival (PFS) and overall survival (OS) are 6.6 (95% CI 5.2-8) and 9.7 months (95% CI 8.2-11.2). 18.7% of patients have grade 3-4 toxicity when receiving treatment. Conclusions: Despite the heterogeneity of the pathologies, and the low evidence, the results obtained in SLP and SG, together with the low toxicity, force us to continue advancing in the evaluation of this type of treatments.


Subject(s)
Humans , Off-Label Use , Medical Oncology , Therapeutics , Pharmaceutical Preparations , Toxicity , Hematology
20.
Enferm. foco (Brasília) ; 11(4): 136-145, dez. 2020. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1146677

ABSTRACT

Objetivo: Investigar os eventos adversos, classificá-los conforme a gravidade e identificar seus fatores relacionados no dia da infusão de células-tronco hematopoéticas. Método: Estudo transversal prospectivo, com 85 pacientes do transplante de células-tronco hematopoéticas (TCTH) de um hospital do Estado de São Paulo, Brasil. Os eventos adversos (EA) foram identificados e classificados pelo Common Terminology Criteria for Adverse Events. Para análise dos dados foram construídos modelos de regressão, considerando o nível de significância de 95% (p≤0,05). Resultados: Cerca de 51% dos pacientes eram do sexo feminino, 41,2% apresentaram índice de comorbidade de risco intermediário/alto, 52,9% eram do grupo alogênico aparentado. Pelo modelo de regressão multinomial, foram considerados fatores associados à gravidade dos EA: maior viabilidade celular (p=0,0352) e o índice de comorbidade pré-TCTH de risco intermediário/alto (p=0,0040). No modelo de regressão linear generalizado, foram considerados fatores associados ao número de EA: maior viabilidade celular (p<0,0001), maior volume total de bolsas infundidas (p=0,0011), TCTH alogênico (p=0,0093), diagnóstico de Linfoma (p=0,0001) e Mieloma Múltiplo (p=0,0136), índice de comorbidade pré-TCTH de intermediário/alto risco (p=0,0010) e criopreservação (p=0,0023). Conclusão: Pacientes de TCTH são suscetíveis a diversos fatores que os predispõe a eventos adversos, o que representa um desafio para o enfermeiro e equipe multidisciplinar. (AU)


Objective: Investigate adverse events, classify them according to severity and identify their related factors on the day of hematopoietic stem cell infusion. Method: Prospective cross-sectional study with 85 patients of the hematopoietic stem cell transplantation (HSCT) in a hospital in the state of São Paulo, Brazil. Adverse events (AE) have been identified and classified by the Common Terminology Criteria for Adverse Events. For data analysis, regression models were built; significance level of 95% (p≤0,05). Results: About 51% of the patients were female, 41.2% had an intermediate/high risk comorbidity index, 52.9% were allogeneic group. The multinomial regression model considered factors associated with severity of AE: greater cell viability (p = 0.0352) and the intermediate/high risk pre-HSCT comorbidity index (p = 0.0040). In the generalized linear regression model, factors associated with the number of AE were considered: greater cell viability (p <0.0001), greater infused volume (p = 0.0011), allogeneic HSCT (p = 0.0093), diagnosis Lymphoma (p = 0.0001) and Multiple Myeloma (p = 0.0136), intermediate/ high risk pre-HSCT comorbidity index (p = 0.0010) and cryopreservation (p = 0.0023). Conclusion: These patients are susceptible to several factors that predispose them to AE, which represents a challenge for nurses and multidisciplinary team. (AU)


Objetivo: Investigar eventos adversos, clasificarlos según su gravedad e identificar sus factores relacionados el día de la infusión de células madre hematopoyéticas. Método: Estudio prospectivo y transversal con 85 pacientes em el trasplante de células madre hematopoyéticas (TCMH), en un hospital en el estado de São Paulo, Brasil. Los eventos adversos (EA) han sido clasificados por los criterios de terminología común para eventos adversos. Se construyeron modelos de regresión; el nivel de significancia del 95% (p≤0,05). Resultados: 51% eran mujeres y 52,9% pertenecía al grupo alogénico relacionado. El modelo de regresión multinomial consideró factores asociados con la gravedad de la EA: una mayor viabilidad celular (p = 0.0352) y el índice de comorbilidad pre-HSCT de riesgo intermedio/alto (p = 0.0040). En el modelo de regresión lineal generalizado, se consideraron factores asociados con número de EA: mayor viabilidad celular (p <0,0001), mayor volumen infundido (p = 0,0011), TCMH alogénico (p = 0,0093), diagnóstico linfoma (p = 0.0001) y mieloma múltiple (p = 0.0136), índice de comorbilidad pre-HSCT de riesgo intermedio/alto (p = 0.0010) y criopreservación (p = 0.0023). Conclusión: Estos pacientes son susceptibles a varios factores que los predisponen a EA, un desafío para las enfermeras y el equipo multidisciplinario. (AU)


Subject(s)
Hematopoietic Stem Cell Transplantation , Oncology Nursing , Drug-Related Side Effects and Adverse Reactions , Toxicity
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