Rapid tranquilization for agitated patients in emergency psychiatric rooms: a randomized trial of olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol alone / Tranquilização rápida para pacientes agitados nos serviços de emergência psiquiátrica: um ensaio clínico randomisado de olanzapina, ziprasidona, haloperidol mais prometazina, haloperidol mais midazolam e haloperidol em monoterapia

OBJECTIVE: To compare the effectiveness of intramuscular olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol alone as the first medication(s) used to treat patients with agitation and aggressive behavior. METHOD: One hundred fifty patients with agitation caused by psychotic or bipolar disorder were randomly assigned under double-blind conditions to receive olanzapine, ziprasidone, haloperidol plus midazolam, haloperidol plus promethazine or haloperidol alone. The Overt Agitation Severity Scale, Overt Aggression Scale and Ramsay Sedation Scale were applied within 12 hours after the first dosage. RESULTS: All medications produced a calming effect within one hour of administration, but only olanzapine and haloperidol reduced agitation by less than 10 points, and only olanzapine reduced aggression by less than four points in the first hour. After twelve hours, only patients treated with haloperidol plus midazolam had high levels of agitation and aggression and also more side effects. Ziprasidone, olanzapine and haloperidol alone had more stable results for agitation control, while ziprasidone, haloperidol plus promethazine and olanzapine had stable results for aggression control. CONCLUSION: Olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol were effective in controlling agitation and aggression caused by mental illness over 12 hours. Although all the drugs had advantages and disadvantages, haloperidol plus midazolam was associated with the worst results in all the observed parameters.

OBJETIVO: Comparar a eficácia da olanzapina, ziprasidona, haloperidol associado ao midazolam, haloperidol associado à prometazina e haloperidol isoladamente por via intramuscular como primeira escolha no tratamento de pacientes em agitação e agressividade. MÉTODO: Cento e cinquenta pacientes com agitação psicomotora por transtorno psicótico ou transtorno bipolar foram recrutados para estudo duplo-cego e receberam olanzapina, ziprasidona, haloperidol associado a midazolam, haloperidol associado a prometazina ou haloperidol isoladamente. Foram aplicadas as escalas Overt Agitation Severity Scale, Overt Aggression Scale e Ramsay Sedation Scale no período de 12 horas após a primeira aplicação. RESULTADOS: Todas as medicações foram capazes de acalmar os pacientes após uma hora da administração. Apenas a olanzapina e o haloperidol reduziram a agitação para menos de 10 pontos e apenas a olanzapina reduziu a agressividade para menos de quatro pontos nesse período. Doze horas depois, apenas o haloperidol com midazolam apresentou valores altos para a agitação e agressividade, e também esteve relacionado com maior proporção de efeitos colaterais. A ziprasidona, a olanzapina e o haloperidol apresentaram resultados mais estáveis para o controle da agitação e a ziprasidona, haloperidol associado a prometazina e olanzapina para o controle da agressividade. CONCLUSÃO: A olanzapina, a ziprasidona, o haloperidol associado a prometazina, o haloperidol associado ao midazolam e o haloperidol isoladamente foram efetivos no controle da agitação e da agressividade secundária a transtornos mentais dentro de 12 horas. Todas as drogas apresentaram vantagens e desvantagens, exceto pela associação haloperidol e midazolam que demonstrou os piores resultados em todos os parâmetros.

Comparison of behavioral and clinical effects of intravenous amitraz or romifidine administration in horses / Comparação de efeitos comportamentais e clínicos da administração intravenosa de amitraz ou romifidina em eqüinos

Clinical and behavioral effects of intravenous injection of romifidine (60mcg/kg) or amitraz (0.4mg/kg) were compared in six horses, over 120 min. Romifidine caused head ptosis (HP), reduced respiratory rate (RR) and ileo-cecal sphincter activity (IC) until 120 minutes; produced posture changes (PC) until 90 minutes, upper eyelid drop (ED) and sedation (SD) until 60 minutes, intestinal motion (IM) reduction and lower lip drop (LD) until 45 minutes. Amitraz reduced heart rate (HR), RR, IM and IC, and promoted HP, ED, LD, penis drop (PD) and sedation with posture changes until 120min. At 90min amitraz produced HP and ED more intensively than romifidine. The LD was similar between 45 and 60 minutes. Romifidine produced intense sedation at 10min while amitraz sedation was more significant between 90 and 120 minutes. It is concluded that both romifidine and amitraz can produce strong sedation until 60 and 120 minutes, respectively. Though amitraz sedation and posture changes had a later onset related to romifidine, these effects lasted longer

Compararam-se os efeitos sedativos e clínicos em seis eqüinos tratados com romifidina (60mcg/kg) ou amitraz (0,4mg/kg), pela via intravenosa, durante 120 minutos. A romifidina promoveu ptose da cabeça (PC), reduziu a freqüência respiratória (FR) e o movimento da válvula íleo-cecal (MC) durante 120 minutos, provocou alteração postural (AP) por 90 minutos, induziu ptose palpebral (PP) e sedação (SD) por 60 minutos, diminuiu a motilidade intestinal (MI) e causou ptose labial (PL) durante 45 minutos. O amitraz reduziu a freqüência cardíaca (FR), FR, MI e MC e provocou PC, PP, PL, prolapso peniano (PP) e sedação com alteração postural por 120 minutos. Aos 90 minutos, o amitraz induziu a PC e a PP mais intensamente que a romifidina; o mesmo ocorreu entre 45 e 60 minutos para PL. A romifidina produziu sedação maior aos 10 minutos; para o amitraz, a sedação foi mais intensa entre 90 e 120 minutos. Conclui-se que a romifidina e o amitraz produzem sedação intensa por 60 e 120 minutos, respectivamente. A sedação e as alterações posturais induzidas pelo amitraz foram de início tardio, porém tiveram maior duração

Consumo de alcohol y otras drogas en embarazadas / Consumption of alcohol and other drugs in pregnant women

La investigación sobre los efectos de las drogas, legales e ilegales, en el embarazo fue planificada, desde su inicio, como una forma de apoyar a quienes se desempeñan en el campo de la prevención y la asistencia a las adicciones en la sociedad uruguaya.Los instrumentos utilizados en la investigación fueron la entrevista cara a cara con la mujer en estado puerperal, dentro de las 48 horas después del nacimiento, los registros perinatales obtenidos de los archivos hospitalarios y las muestras de meconio de los recién nacidos las cuales fueron analizadas en la búsqueda de alcohol, tabaco, psicofármacos y drogas ilegales. La encuesta mostró un consumo durante la gestación de 41,7% de tabaco, 37% de alcohol, 16,5% de tranquilizantes, 68% de cafeína (mas de 400 mg/día), 1,5% de marihuana y 0,4% de pasta base.Las pruebas sobre meconio indicaron que el consumo en el embarazo fue de tabaco 51%, alcohol 40%, tranquilizantes 2,5%, marihuana 2%, anfetaminas 8,3%, cocaína/pasta base 2,5% y opiáceos 0,5%. La investigación encontró que 11% de los recién nacidos de la muestra fueron de bajo peso, y que 15% tuvieron problemas de salud. Los neonatos de madres fumadoras presentaron pesos al nacer estadísticamente más bajos que los restantes. Se halló asimismo que 8,9% de las madres carecían de control prenatal. El 34% de los médicos que controlaron el embarazo advirtió a las gestantes sobre los riesgos del hábito de fumar durante el embarazo, el 27% lo hizo en relación al consumo de alcohol y 7% sobre el uso de drogas ilegales.

The objective of the study was to estimate the prevalence of drug consumption during pregnancy through an interview and biological samples and to investigate the information given concerning risks about drug consumption during pregnancy. The 1000 interviews performed were personal within 48 hours after labor, using perinatal registries taken from hospital archives. The meconium samples were tested for alcohol, tobacco, illegal drugs and tranquilizers. Through the survey, the results about consumption during pregnancy was 41.3 % for tobacco, alcohol 36.8%, tranquilizers 16.3%, caffeine 68% (more than 400 mg/day), cannabis 1.5% and 0.4% for base paste.The consumption in the meconium samples was 51.8% for tobacco, 43.5% for alcohol, 2.5% for tranquilizers, 2% for cannabis, 8.3% for amphetamines, 2.5% for cocaine/ base paste and 0.5% for opiates. 11 % of all newborns had low birth weight and 14.8 % had health problems. Newborns from smoking mothers had lower birth weights. 8,9 % of all the mothers did not control their pregnancy. Physicians who controlled the pregnancies warned their patients about associated risks with tobacco in 34%, 27% for alcohol and 7% for illegal drugs.

Roncópatas versus roncópatas con apneas: ¿pueden diferenciarse clínicamente? / Snorers versus snorers with apnea: can they be clinically differenciated?

El diagnóstico del síndrome de apnea obstructiva del sueño (SAOS) se realiza con el polisomnograma de sueño, examen de considerable costo económico para el paciente. Se han diseñado algunas herramientas, como el score de Epworth, con el fin de predecir si un paciente tiene o no un SAOS. Se pretende investigar si existen diferencias entre pacientes roncadores y pacientes con SAOS que permitan al clínico establecer el diagnóstico y severidad del SAOS con mayor certeza previo al polisomnograma de sueño. Además, evaluar el valor predictivo del score de Epworth. Para ello se efectuó un estudio retrospectivo de fichas clínicas y polisomnogramas de sueño en 220 pacientes roncadores. El presente estudio encontró que la edad fue el único parámetro distinto estadísticamente significativo entre roncadores y SAOS, siendo estos últimos poseedores de una mayor edad. No hubo diferencias en patologías asociadas, consumo de medicamentos, score de Epworth, examen otorrinolaringológico e índice de masa corporal (IMC). En pacientes con SAOS se observó que, a mayor IMC existía un mayor nivel de desaturación de oxígeno nocturno. El score de Epworth tuvo un valor predictivo positivo (VPP) de 88,4 por ciento, y un valor predictivo negativo (VPN) de 20 por ciento. Se concluye que no es posible predecir clínicamente si un paciente es portador de un SAOS.

Consumo de substancias que producen dependencia en Colombia / Consumption of dependency-producing substances in Colombia

In 1987 a study was made of the consumption of dependency-producing substances in the urban population of Colombia. For this purpose the prevalence survey method was applied to a representative sample of 2,800 individuals between the ages of 12 and 64. The descriptive analysis was supplemented by the exploration of causal associations and measurement of the strength of such associations by means of the prevalence ratio coupled with calculation of the degree of statistical significance. The study included three substances whose consumption is socially accepted - alcohol, tobacco, and tranquilizers - and another three considered to be illicit - basuco (coca-paste), cacaine, and marijuana. Alcohol and tobacco were the two drugs most used by both sexes (560 and 297 per 1,000 subjects studied, respectively.) Tranquilizers, the only one of the drugs in the study that was used more by women, ranked third (60 per 1,000). Reported in much smaller proportions were marijuana (11 per 1,000), basuco (6 per 1,000), and cocaine (3 per 1,000). It may be noted that the consumption of basuco has recently reached a level double that of cocaine. Analysis of the use and abuse of these substances by age, marital status, socioeconomic situation, and other variables indicates that the prevalence of consumption is higher in the medium age groups

Prevalencia del uso indebido de alcohol, tabaco y drogas en la poblacion ecuatoriana / Prevalence of the improper use of alcohol, tobacco, and drugs in the ecuadorian population

An epidemiological investigation was conducted in 1988 to measure prevalence of the improper use of alcohol, tobacco, and illegal drugs in the Ecuadorian population. This research was based on a structured survey of 185 questions that was carried out on a probabilistic random sample of 6,000 individuals representative of the country's entire population between the ages of 10 and 65. The relative frequency of the various common forms of consumption of these substances was also investigated. The highest prevalences of addiction corresponded to alcohol and tobacco (13 percent), followed by tranquilizers (0.8 percent), opiates (0.4 percent), barbiturates and marijuana (0.2 percent), and cocaine base (0.11 percent). The most common form of consumption was experimental, followed by recreational and psychopathological, as a stimulant, and as an anesthetic. Some of the substances were shown to be related to specific forms of consumption, which in the future will serve as a basis for establishing policies for prevention, treatment, and rehabilitation

Tratamiento de la enfermedad acidopeptica / Treatment of the acidpeptic disease

Se hace una revision del tratamiento de la enfermedad acidopeptica, definiendo para el efecto, las drogas existentes y su utilidad. Se clasifican en aquellas que modfician el factor acido (antiacidos, anticolinergicos, antogonistas de los receptores H2 y los Benzimidazoles sustitiudos), las que aumentan la resistencia (sucralfate, bismutos y carbenoxolona), y otras (tranquilizantes y neurolepticos y las prostaglandinas). Se discuten los esquemas terapeuticos utilizados. Finalmente se hacen algunas anotaciones sobre la importancia que tiene la cirugia en el tratamiento de la enfermedad acidopeptica