Reacciones adversas por salbutamol en pacientes asmáticos: reflexiones acerca del uso en las exacerbaciones / Adverse reactions from salbutamol in asthmatic patients: reflections on its use and exacerbations / Reações adversas ao salbutamol em pacientes asmáticos: reflexões sobre o seu uso e exacerbações

Las afecciones respiratorias agudas son la primera causa de consulta e ingreso hospitalario en los meses de invierno, y entre ellas el asma ocupa un lugar preponderante. El salbutamol es un broncodilatador con eficacia demostrada en las exacerbaciones y se utiliza de primera línea en el tratamiento. El objetivo de la presente comunicación es analizar dos casos clínicos de niños asmáticos que presentaron efectos adversos al salbutamol y requirieron el ingreso en la Unidad de Terapia Intensiva. Se propone revisar los efectos adversos del salbutamol empleado en crisis asmáticas y analizar las alternativas terapéuticas en esta enfermedad. Los síntomas de los efectos secundarios pueden confundirse con los causados por la propia enfermedad, por lo que puede usarse el fármaco de modo excesivo y es importante conocer el perfil posológico y caracterizar los posibles efectos secundarios en los pacientes para usar de manera racional y segura este medicamento.

Acute respiratory conditions are the first cause of consultation and hospital admission in the Winter months, being asthma the most important. Salbutamol is a bronchodilator with proven efficacy in exacerbations used first-line in treatment. The objective of this paper is to analyze two clinical cases of asthmatic children who presented adverse effects to salbutamol and required admission to the Intensive Care Unit. It is proposed to review the adverse effects of salbutamol used in asthmatic crises and to analyze therapeutic alternatives in this disease. Symptoms of side effects can be confused with those caused by the disease itself, determining the excessive use of this drug, thus, it is important to know the dosage profile and characterize the possible side effects to make rational and safe use of this drug.

As doenças respiratórias agudas são a primeira causa de consultas e internações nos meses de inverno e a asma ocupa é a mais importante. O salbutamol é um broncodilatador com eficácia comprovada nas exacerbações e é usado como tratamento de primeira linha. O objetivo desta comunicação é analisar dois casos clínicos de crianças asmáticas que apresentaram efeitos adversos ao salbutamol e necessitaram de internação em Unidade de Terapia Intensiva. Propõe-se revisar os efeitos adversos do salbutamol utilizado na crise asmática e analisar as alternativas terapêuticas nessa doença. Os sintomas de efeitos colaterais podem ser confundidos com os causados pela própria doença, determinando o uso excessivo desse medicamento, sendo importante conhecer o perfil posológico e caracterizar os possíveis efeitos colaterais nos pacientes para fazer um uso racional e seguro desse medicamento.

Occupational exposure to pesticides and health symptoms among family farmers in Brazil

ABSTRACT OBJECTIVE: To explore the association of occupational pesticide exposure with acute and mental health symptoms. METHODS: Cross-sectional survey carried out with 78 Brazilian family farmers, who were pesticide applicators and helpers conveniently selected. Symptoms and exposure data were collected by interviews, and mental health outcomes by the Self-Reporting Questionnaire. Blood samples were analyzed to assess cholinesterase levels. Exposure indicators and symptoms were compared between applicators and helpers, and Poisson regression was performed to estimate prevalence ratios. RESULTS: Farmers reported exposure to multiple pesticides from early ages; they worked without safety training, technical support, and full protective equipment, and they had a high prevalence of acute and mental health symptoms (e.g., headache, mucosal irritation, tachycardia, and depressive signs). Applicators had more cholinesterase changes than helpers, but less symptoms. Helpers used less personal protection and had significantly higher prevalence ratio of headache, dyspnea, wheezing, cough, poor digestion, tiredness, and feeling worthless, after adjustment. CONCLUSIONS: Acute and mental health symptoms were observed, both among farmers and helpers. Thus, surveillance actions must be reinforced in Brazil, technical support and safety training improved, focused on applicators and helpers, who are occupationally and environmentally exposed to pesticides. Agricultural practices of these groups with less pesticide use should receive incentive.

Blood electrolyte disturbances during severe hypoglycemia in Korean patients with type 2 diabetes

BACKGROUND/AIMS: To investigate abnormalities in blood electrolyte levels during severe hypoglycemia in Korean patients with type 2 diabetes mellitus (T2DM) in a clinical setting. METHODS: Blood electrolyte levels in adult T2DM patients during severe hypoglycemia were collected from January 1, 2008 to December 31, 2012. Patients who maintained normal serum creatinine and blood urea nitrogen levels were utilized in the study. Severe hypoglycemia was defined as a condition requiring medical assistance, such as administering carbohydrates when serum glucose levels less than 70 mg/dL were observed, in conjunction with other symptoms of hypoglycemia. RESULTS: A total of 1,068 patients who visited the emergency room with severe hypoglycemia were screened, of which 219 patients were included in this study. The incidence of abnormal levels for any electrolyte was 47%. Hypokalemia ( 100 beats per minute) and severe hypertension (> or = 180/120 mmHg) were 30 mg/dL (range, 14 to 62) and 35 mg/dL (range, 10 to 69; p = 0.04), 18.8% and 7.2% (p = 0.02), and 20.8% and 10.2% (p = 0.05) in the hypokalemia and normokalemia groups, respectively. CONCLUSIONS: During severe hypoglycemia, hypokalemia occurred in 21.9% of T2DM patients and was associated with tachycardia and severe hypertension. Therefore, the results suggest that severe hypoglycemia may increase cardiovascular events in T2DM.

Myocardial damage in hair dye poisoning--an uncommon presentation.

A 22-year-old female presented to us after consuming hair dye with features of angio-neurotic edema, asphyxia and irregular pulse. Serial ECGs revealed presence of ST segment elevation and T wave inversion in anterior chest leads. Strongly positive c-troponin-T test further confirmed the myocardial damage. This is a rare manifestation of para-phenylene diamine poisoning mentioned in literature. Patient also had elevated liver enzymes and oliguria.

Vaginal misoprostol in managing premature rupture of membranes

We compared the efficacy of misoprostol with that of prostaglandin E2 in cervical ripening and labour induction. Thus 238 women with rupture of membranes beyond 36 weeks gestation without labour were randomized to receive 50 microg misoprostol vaginal gel or 5 mg of prostaglandin E2 gel. Bishop score was evaluated before drug application and 6 hours later. Clinical data and perinatal outcome were recorded. Mean time from induction to delivery and the need for oxytocin were significantly less in the misoprostol group. There were no significant differences in spontaneous labour rate, type of delivery and perinatal outcome. It is concluded that intravaginal misoprostol is safe and more effective than prostaglandin E2 for preinduction cervical ripening in premature rupture of membranes beyond 36 weeks gestation

Bromocriptine-induced tachycardia in conscious rats: blunted response followin isoproterenol pretreatment for 5 days

Previous studies have shown that tachycardia induced by intravenous injection of bromocriptine, which persisted after adrenalectomy, was mediated by central dopamine D2 receptor stimulation. Such stimulation could activate central sympathetic outflow to the heart. To test this hypothesis, we investigated whether pretreatment with isoproterenol, known to induce cardiac beta-adrenoceptor desensitization, could reduce bromocriptine-induced tachycardia. A 5 day pretreatment with isoproterenol (5 mg/Kg/day) induced a 21 per cent increase in the ratio of ventricular dry weight to body weight, compared with saline-pretreated rats. In isolated perfused heart preparations from isoproterenol-pretreated rats, the isoproterenol-induced increase in left ventricular systolic pressure and heart rate was significantly reduced, compared with saline-pretreated rats (the isoproterenol concentration producing 50 per cent of the maximal positive inotropic and chronotropic responses was increased ~5-and 4- fold, respectively). In conscious control rats, intravenous injection of bromocriptine (50, 150 and 250 mug/Kg) decreased mean aortic pressure and increased heart rate in a dose-related manner. Pretreatment with isoproterenol for 5 days reduced bromocriptine-induced tachycardia without affecting hypotension. Cardiac autonomic tone remained of the same order of magnitude irrespective of whether the animal was pretreated with isoproterenol. These results indicate that isoproterenol pretreatment reduces bromocriptine-induced tachycardia mainly through desensitization of cardiac beta-adrenoceptors rather than via an impairment of autonomic regulation of the heart. This support the hypothesis that bromocriptine-induced activation of central dopamine D2 receptors increases heart rate via activation of central sympathetic outflow to the heart.

Menor sensibilidad al efecto taquicardizante inducido por estimulación betaadrenérgica en pacientes con síncope neurocardiogénico / Decreased sensitivity to the tachycardial effect induced by beta adrenergic stimulation in patients with neurocardiogenic syncope

Tradicionalmente se ha postulado una mayor sensibilidad miocárdica a las catecolaminas como parte del mecánismo desencadenante del síncope neurocardiogénico (SNC). Hemos evaluado la hipótesis de que, contrariamente a lo aceptado, estos pacientes tienen una menor sensibilidad al efecto taquicardizante (beta 1) de la estimulación betaadrenérgica mediante la determinación del parámetro dosis efectiva 30-50 de isoproterenol. Se estudió en forma consecutiva a 101 pacientes con síncope de etiología no precisada mediante Tilt Test (TT, 70º) con isoproterenol, 46 pacientes con TT + y 55 con TT-, comparables en edad, sexo, peso y talla. El objetivo farmacológico al administrar isoproterenol durante el TT fue aumentar la frecuencia cardiaca de 30 por ciento-50 por ciento sobre la frecuencia cardiaca basal. Los pacientes con SNC requirieron dosis de isoproterenol significativamente mayores para alcanzar dicho objetivo (2,1 ñ 0,13 vs 1,35 ñ 0,09 µg/min/m²). En conclusión, nuestros datos sugieren que los pacientes con SNC tienen menor sensibilidad al efecto taquicardizante inducido por betaestimulación

Evaluation of amlodipine in mild to moderate hypertension--a clinical report.

Twenty two patients having mild to moderate hypertension were treated with a single daily dose of amlodipine for 4 weeks. Satisfactory response defined as final diastolic blood pressure < 90 mm of Hg and a reduction from baseline values > 10 mm of Hg could be achieved in 81.8% of patients in supine position and 70% of patients in standing position. Thirteen patients responded to 5 mg dose and 9 patients required 10 mg. Postural hypotension and reflex tachycardia were absent. Three patients has mild leg cramps and constipation. No deleterious effects were observed on liver, kidney and hemopoetic function, or on E.C.G. Changes. Amlodipine given once daily is effective and safe, and is a useful addition to the existing armamentarium of antihypertensive drugs.

A study on withdrawal related haemodynamic response in chronic propranolol treated conscious rats.

Single dose of propranolol hydrochloride (5 mg/kg, i.p.) caused significant fall in heart rate (HR) but not in systolic blood pressure (SBP) in normotensive conscious rats. Multiple doses of propranolol (5 mg/kg, i.p., twice-a-day for 5 wk) caused significant fall in both HR and SBP at 2 wk and 4 wk in normotensive conscious rats. Sudden withdrawal of propranolol at 5 wk caused a significant blood pressure upswing and tachycardia between 12-24 h followed by normalization of both blood pressure and heart rate. The study documents a possible model of rebound hypertension in normotensive conscious rats.

Reversion of ventricular and supraventricular tachycardia by magnesium sulphate therapy in aluminium phosphide poisoning. Report of two cases.

Two patients with aluminium phosphide poisoning developed supraventricular tachycardia and ventricular tachycardia (one each). These reverted successfully with magnesium sulphate therapy.

Influence of general anesthetics on baroreflex control of circulation

1. The effects of sodium pentabarbital and alfa-chloralose anesthesia on the barreflex control of ciruclation were studied in groups of 7 to 11 rats. The tests were performed in conscious undisturbed rats and repeated after anesthesia. 2. Pentobarbital (15 min) depressed the initial peak of the pressor response produced by carotid occlusion by 68% (15 ñ 1 vs 47 ñ 3 mmHg) and the mainteined rsponse by 52% (13 ñ 1 vs 27 ñ 4). Depression by chloralose was 48% (26 ñ 5 vs 50 ñ 3) and (19 ñ 2 vs 24 ñ 3), respectively. The inhibition progressively declined at 30, 60.90 and 120 min after pentobarbital but was unchanged up to 120 min after chloralose. 3. The baroreflex sensitivity index for bradycardic responses (phenylephrine injection) diminished by 50% after pentobarbital (-1.1 ñ 0.3 vs -2.2 ñ 0.3 beats/min per mmHg) and remained unaltered after chloralose. 4. The baroreflex sensitivity index for tachycardic responses (nitroprusside injection) was depressed by 61% after pentobarbital (-1.5 ñ 0.5 vs -3.8 - 0.5 beats/min per mmHg) and 35% after chloralose (-2.5 ñ 0.2 vs -3.9 ñ 0,5). 5. In general the depression of reflex control of ciruclation was more severe after pentobarbital than after chloralose anesthesia, while the resting control arterial pressurte was not affected by either. The inhibition of the baroreflex tachycardic responses was more intense than that of the bradycardic responses and represented a betther index of the depression exerted on the pressure responses to carotid occlusion

Significance of heart rate response in shock due to aluminium phosphide poisoning.

Mixed heart rate response has been observed in shock due to aluminium phosphide poisoning. Bradycardia observed in 9 of 30 cases studied indicated transient vagotonia and it reversed with atropine. Both tachycardiac bradycardiac responses were associated with significant increase in the mortality.

Cardiotoxicidade na intoxicaçäo aguda por antidepressivo tricíclico: relato de caso / Cardiotocicity in acute poisoning by tricyclic antidepressives: a case report

As intoxicaçöes agudas por antidepressivos tricíclicos estäo entre as primeiras causas de morte por ingestäo de drogas. As manifestaçöes neurológicas e cardiológicas responsáveis pela gravidade de tais intoxicaçöes säo extremamente importantes. É apresentado o caso de uma paciente, de 26 anos que ingeriu 1500 mg de amitriptilina sendo observada taquicardia sinusal com BAV de 1§ grau revertido com salicilato de fisostigmine

The automatic implantable cardioveter defibrillator: case report

A patient with polymorphous ventricular tachycardia is decribed. Because of the occurrence of ventricular fibrillation on two occasions, in spite of drug therapy, and the presence of ischemic heart disease, the patient was referred for insertion of an automatic implantable cardioverter defibillator (AICD) and coronary revascularization, which was cone at Washington, D.C. at the Veterans Administration Hospital. Patient has remained asymtomatic (11 months follow-up) and a repeated exercise test after ssurgery failed to reproduce the arrythimia. To our knowledge this is the firsr Puerto Rican patient in which an AICD has been implanted .

Un modelo experimental de la taquicardia ventricular helicoidal (Torsades de pointes): comunicación preliminar / An experimental model of ventricular belicoidal tachycardia (torsades de ponintes): preliminary communication

Se llevaron a cabo experimentos en 20 perros. Con el tórax abierto se inyectó aconitina en el espesor del septum interventricular. Se registró D y derivaciones directas en epicardio de la aurícula derecha, en las superficies septales derecha e izquierda y en el haz de His. Terminado el estudio se extrajo el corazón para comprobar la colocación de los electrodos y el sitio de aplicación de la aconitina. Se obturo TVH en 15 perros, con un giro de 180- durante el episodio. El giro del AQRS se hizo con un latido de dirección intermedia que correspondió a una captura ventricular por un latido sinusal o por un "eco" ventricular. Después de ese latido se estableció una secuencia de activación AHV en varios latidos, el primero de ellos con AH alargado (p<0.01). El siguiente cambio de dirección del QRS se hizo cuando se perdió esa secuencia de activación y hulo disociación A-V como al principio del episodio. En conclusión, en el modelo experimental utilizado, la TVH se produjo por un doble mecanismo, un foco de automatismo aumentado y una macroreentrada que involucra las dos ramas del haz de His, el nodo A-V y la aurícula

Taquicardia ventricular helicoidal inducida por amitriptilina: presentación de un caso / Helicoid ventricular tachycardia induced by amytriptilini: report of a case

Se presenta el caso de una paciente atendida en el Servicio de psiquiatría por melancolía involutiva que fué tratada con amitriptilina a dosis terapeúticas, y quien manifestó clínicamente crisis de Stokes-Adams y electrocardiográficamente síndrome de QT prolongado y taquicardia ventricular helicoidad (TVH). Se consideró como factor desencadenante de ésta arritmia la asociación de antidepresivos tricíclicos así como hipokalemia. Considerada la probable dispersión del período refractario como la causa fundamental de la arritmia, la paciente fue tratada con isoproterenol intravenoso, lográndose reversión inmediata de dicha arritmia ventricular (torsade de pointes) y temprana de la prolongación del QT