Otorhinolaryngological adverse effects of urological drugs

ABSTRACT Purpose: To describe the otorhinolaryngological adverse effects of the main drugs used in urological practice. Materials and Methods: A review of the scientific literature was performed using a combination of specific descriptors (side effect, adverse effect, scopolamine, sildenafil, tadalafil, vardenafil, oxybutynin, tolterodine, spironolactone, furosemide, hydrochlorothiazide, doxazosin, alfuzosin, terazosin, prazosin, tamsulosin, desmopressin) contained in publications until April 2020. Manuscripts written in English, Portuguese, and Spanish were manually selected from the title and abstract. The main drugs used in Urology were divided into five groups to describe their possible adverse effects: alpha-blockers, anticholinergics, diuretics, hormones, and phosphodiesterase inhibitors. Results: The main drugs used in Urology may cause several otorhinolaryngological adverse effects. Dizziness was most common, but dry mouth, rhinitis, nasal congestion, epistaxis, hearing loss, tinnitus, and rhinorrhea were also reported and varies among drug classes. Conclusions: Most of the drugs used in urological practice have otorhinolaryngological adverse effects. Dizziness was most common, but dry mouth, rhinitis, nasal congestion, epistaxis, hearing loss, tinnitus, and rhinorrhea were also reported. Therefore, doctors must be aware of these adverse effects to improve adherence to the treatment and to minimize damage to the health of patients.

Anestesia intravenosa contínua com cetamina racêmica ou dextrocetamina e detomidina em cadelas / [Continuous intravenous anesthesia with racemic ketamine or dextroketamine and detomidine in female dogs]

Objetivou-se com este estudo comparar a associação de detomidina e cetamina ou dextrocetamina, por via intravenosa contínua, em oito cadelas submetidas a dois protocolos: GCD - indução anestésica com 5mg/kg e infusão intravenosa contínua de 20mg/kg/h de cetamina; e GDD - indução com 3,5mg/kg e infusão de 14mg/kg/h de dextrocetamina. Associou-se detomidina, 30µg/kg/h, em ambos os grupos. Registraram-se frequência cardíaca (FC), pressão arterial (PA), frequência respiratória (f), temperatura (TC), miorrelaxamento, analgesia, hemogasometria e eletrocardiograma, antes e 15 minutos após a MPA (Mbasal e Mmpa); após o início da infusão (Mic); a cada 10 minutos até 90 minutos (M10, M20, M30, M40, M50, M60, M70, M80 e M90); e 30 minutos após o fim da infusão (M120). Foi observada bradicardia em Mmpa no GCD e de Mmpa a M10 no GDD. Ocorreu hipotensão em Mmpa e hipertensão a partir de Mic. A f diminuiu de M10 a M30. Foram observados: onda T de alta amplitude, bloqueios atrioventriculares e parada sinusal. Ocorreu acidose respiratória. O período de recuperação foi de 219,6±72,3 minutos no GCD e de 234,1±96,8 minutos no GDD. A cetamina e a dextrocetamina, associadas à detomidina por infusão contínua, causam efeitos cardiorrespiratórios e anestésicos similares.(AU)

The combination of detomidine and ketamine or dextrocetamine for continuous intravenous infusion was compared in eight female dogs submitted to two protocols: GCD - 5mg/kg of anesthetic induction and continuous intravenous infusion of ketamine 20mg/kg/h; and GDD - induction with 3.5mg/kg and infusion of 14mg/kg/h of dextrocetamine. Detomidine, 30µg/kg/h was associated in both groups. Heart rate (HR), blood pressure (BP), respiratory rate (RR), temperature (CT), myorelaxation, analgesia, blood gas analysis and electrocardiogram were recorded before and 15 minutes after MPA (Mbasal and Mmpa); after the start of infusion (Mic); every 10 minutes to 90 minutes (M10, M20, M30, M40, M50, M60, M70, M80 and M90); and 30 minutes after the end of infusion (M120). Bradycardia was observed in Mmpa in GCD and from Mmpa to M10 in GDD. There was hypotension in Mmpa and hypertension from Mic. The RR decreased from M10 to M30. High amplitude T wave, atrioventricular blocks and sinus arrest were observed. Respiratory acidosis occurred. The recovery period was 219.6±72.3 minutes in GCD and 234.1±96.8 minutes in GDD. Ketamine and S+ ketamine associated with detomidine for continuous infusion cause cardiorespiratory and similar anesthetic effects.(AU)

Epinephrine in pediatric cardiorespiratory arrest: when and how much? / Epinefrina na parada cardiorrespiratória pediátrica: quando e quanto?

ABSTRACT The objective of the present study was to assess the efficacy of different doses, times for infusion of the first dose, intervals of administration of subsequent doses, and number of epinephrine doses in the survival of children and adolescents who went into cardiorespiratory arrest. It is a review study with data from the PubMedⓇ/MEDLINEⓇdatabase. The search was for articles published from January 1st, 2000 to February 10, 2019, with a sample of patients aged under 18 years, published in English, Portuguese and Spanish. We found 222 articles, of which 16 met the inclusion criteria of the study. The first dose should be given as soon as possible. The standard dose (0.01mg/kg) has a better outcome when compared to the higher dose (0.1mg/kg). There is an iⓇverse relation between the number of epinephrine doses and survival. The interval currently recommended between doses has lower survival when compared to larger intervals. The dosage recommended by the American Heart Association presents a better outcome for survival, but the interval between doses and the maximum number of doses should be better assessed.

RESUMO O objetivo deste estudo foi avaliar a eficácia de diferentes doses, tempos para infusão da primeira dose, intervalos de administração de doses subsequentes e número de doses de epinefrina na sobrevida de crianças e adolescentes que sofreram parada cardiorrespiratória. Trata-se de estudo de revisão, cujas buscas foram feitas na base de dados PubMedⓇ /MEDLINEⓇ. Foram selecionados artigos publicados de 1° de janeiro de 2000 até 10 de fevereiro de 2019, realizados em menores de 18 anos de idade, publicados em inglês, português e espanhol. Foram encontrados 222 artigos, dos quais 16 atenderam os critérios de inclusão no estudo. A primeira dose deve ser aplicada o mais rápido possível. A dose padrão (0,01mg/kg) apresenta melhor desfecho quando comparada à dose alta (0,1mg/kg). Houve relação inversa entre número de doses de epinefrina e sobrevida. O intervalo entre doses recomendado atualmente apresenta menor sobrevida quando comparado a intervalos maiores. A dose recomendada pela American Heart Association apresenta melhor desfecho para sobrevida, porém o intervalo entre doses e o número máximo de doses devem ser melhor avaliados.

Dexmedetomidine: present and future directions / 대한마취과학회지

Dexmedetomidine is a potent, highly selective α-2 adrenoceptor agonist, with sedative, analgesic, anxiolytic, sympatholytic, and opioid-sparing properties. Dexmedetomidine induces a unique sedative response, which shows an easy transition from sleep to wakefulness, thus allowing a patient to be cooperative and communicative when stimulated. Dexmedetomidine may produce less delirium than other sedatives or even prevent delirium. The analgesic effect of dexmedetomidine is not strong; however, it can be administered as a useful analgesic adjuvant. As an anesthetic adjuvant, dexmedetomidine decreases the need for opioids, inhalational anesthetics, and intravenous anesthetics. The sympatholytic effect of dexmedetomidine may provide stable hemodynamics during the perioperative period. Dexmedetomidine-induced cooperative sedation with minimal respiratory depression provides safe and acceptable conditions during neurosurgical procedures in awake patients and awake fiberoptic intubation. Despite the lack of pediatric labelling, dexmedetomidine has been widely studied for pediatric use in various applications. Most adverse events associated with dexmedetomidine occur during or shortly after a loading infusion. There are some case reports of dexmedetomidine-related cardiac arrest following severe bradycardia. Some extended applications of dexmedetomidine discussed in this review are promising, but still limited, and further research is required. The pharmacological properties and possible adverse effects of dexmedetomidine should be well understood by the anesthesiologist prior to use. Moreover, it is necessary to select patients carefully and to determine the appropriate dosage of dexmedetomidine to ensure patient safety.

Avaliação farmacológica da detomidina no trato reprodutivo de éguas (Equus caballus)

A Detomidina é um agonista de receptores α2-adrenérgico, derivado imidazólico alcalóide, disponível sobre a fórmula de cloridrato, apresentarelação de seletividade entre receptor α2/α1de 260/1. O experimento foi conduzido para investigar a interferência da detomidina sobre o trato reprodutivo equino. Foram utilizadas vinte e cinco éguas sem raça definida (SRD), não prenhes, com idade entre 4 a 10 anos e peso de 350 a 450 Kg. As 25 éguas foram divididas de forma aleatória em 5 grupos, sendo que 3 grupos foram submetidos respectivamente a doses de 6, 9 e 12μg/kgde detomidina.Nos outros dois grupos, um deles foi aplicado Ioimbina em dose 0,10mg/Kg com antecedência de 20 minutos da aplicação de 6μg/kg de detomidina e o outro grupocontrole. Foram realizadas ultrassonográfias no modo B e Doppler do trato reprodutivo de éguas. O índice de pulsatilidade(IP), resistência (IR) e pulso arterial uterino direito (PAUD), bem como a avaliação subjetiva do útero e mesométrio de suprimento sanguíneo, não apresentaram diferençasignificativa(P0,0001) aos 10 minutos e 4,9±0,18mm (P>0,0001) aos 15 minutos, respectivamente...

The Detomidine is an agonist of α2-adrenergic receptors, derived imidazole alkaloid, available on the hydrochloride formula, is related to selectivity between receptor α2/α1of 260/1. The experiment was conducted to investigate the interference of detomidine on equine reproductive tract. Twenty-five mares were used mongrel, not pregnant, aged between 4-10 years old and weighing 350-450kg. The 25 mares were divided randomly into 5 groups, with 3 groups were submitted at doses of the detomidineof 6, 9 and 12μg/kg,respectively. In the other two groups, one applied yohimbine dose of 0.10 mg/kg 20 minutes prior to the application of 6μg/kg detomidine and in control group. All they were made sonographic evaluations in B mode and Doppler of the reproductive tract of mares. The pulsatility index (PI), resistance index (RI) and uterine blood right wrist (UBRW) and the subjective evaluation of the uterus and mesometriumblood supply, showed no significant difference (P0.0001) to 5 minutes, 2.7 ± 0.26 (P>0.0001) after 10 minutes and 4.9 ± 0.18 mm (P>0.0001) after 15 minutes, respectively...

Pathogenesis and Individualized Treatment for Postural Tachycardia Syndrome in Children / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>Postural tachycardia syndrome (POTS) is one of the major causes of orthostatic intolerance in children. We systematically reviewed the pathogenesis and the progress of individualized treatment for POTS in children.</p><p><b>DATA SOURCES</b>The data analyzed in this review are mainly from articles included in PubMed and EMBASE.</p><p><b>STUDY SELECTION</b>The original articles and critical reviews about POTS were selected for this review.</p><p><b>RESULTS</b>Studies have shown that POTS might be related to several factors including hypovolemia, high catecholamine status, abnormal local vascular tension, and decreased skeletal muscle pump activity. In addition to exercise training, the first-line treatments mainly include oral rehydration salts, beta-adrenoreceptor blockers, and alpha-adrenoreceptor agonists. However, reports about the effectiveness of various treatments are diverse. By analyzing the patient's physiological indexes and biomarkers before the treatment, the efficacy of medication could be well predicted.</p><p><b>CONCLUSIONS</b>The pathogenesis of POTS is multifactorial, including hypovolemia, abnormal catecholamine state, and vascular dysfunction. Biomarker-directed individualized treatment is an important strategy for the management of POTS children.</p>

Migração e invasão do câncer de boca via ativação de receptor beta 2 adrenérgico por mediador do estresse / Cell migration and invasion of oral cancer via activation of beta 2 adrenergic receptor by stress mediator

A ativação do receptor beta 2 adrenérgico (β2-AR), pelos mediadores químicos do estresse, pode induzir efeitos estimuladores ou inibidores na migração e invasão celular, dependendo do tipo de tumor maligno. A importância deste receptor na evolução do câncer de boca não está totalmente esclarecida. O objetivo deste estudo foi verificar a expressão do β2-AR em linhagens de carcinomas espinocelular de boca (SCC-9 e SCC-25), e investigar o papel da ativação deste receptor pela norepinefrina e de seu bloqueio por um antagonista na migração e invasão destas células neoplásicas. As células SCC-9 e SCC-25 foram investigadas quanto à expressão gênica e proteica do β2-AR, respectivamente, pelo RT-qPCR e pelo Western blot. A migração e a invasão celular foram analisadas pelo ensaio de cicatrização de feridas e pelo sistema de câmeras de invasão Transwell, respectivamente. Diferentes concentrações (0,1; 1 e 10μM) de norepinefrina foram utilizadas para estimular e 1μM de propranolol foi empregado para bloquear os receptores beta adrenérgicos nas células neoplásicas. As diferenças das médias obtidas nos experimentos de invasão e migração de SCC-9 e SCC-25 e da expressão proteica do β2-AR, foram comparadas pelo teste t de Student com nível de significância de 5%. Os resultados mostraram que a expressão gênica e proteica do β2-AR foi verificada em ambas as linhagens de câncer de boca. A concentração de 10μM de norepinefrina inibiu, significativamente (p≤0,05), a migração e invasão celular de SCC-9 e SCC-25, sendo este efeito mais acentuado nas células SCC-25. Além disso, houve uma redução significativa (p≤0,05) do efeito da norepinefrina na migração celular quando os β2-AR foram inibidos pelo propranolol. Adicionalmente, o bloqueio dos β-ARs pelo propranolol reverteu parcialmente o efeito da norepinefrina na capacidade invasiva de SCC-9 e SCC-25. Estes resultados comprovam que a norepinefrina, via ativação do β2-AR, reduziu a migração e a invasão das...

The activation of beta 2 adrenergic receptor (β2-AR), by chemical mediators of stress, can induce stimulatory or inhibitory effects on cell migration and invasion, depending on the type of malignancy. The importance of this receptor in the oral cancer outcome is not fully understood. The aim of this study was to verify β2- AR expression in oral squamous cell carcinoma cell lines (SCC-9 and SCC-25), and to investigate the role of activation of this receptor by norepinephrine and its blockade by an antagonist in migration and invasion of these neoplastic cells. SCC-9 and SCC-25 cells were investigated for gene and protein expression of β2-AR, respectively, by RT-qPCR and Western blot. The cell migration and invasion were analyzed by wound healing assay and Transwell invasion camera system, respectively. Different concentrations (0.1, 1 and 10μM) of norepinephrine were used to stimulate and 1μM propranolol was used to block the beta adrenergic receptors on cancer cells. Differences in mean values of the invasion and migration assays of SCC-9 and SCC-25 and β2-AR protein expression were compared by the Student t test with 5% significance level. The results showed that β2-AR gene and protein expression was verified in both oral cancer cell lines. The concentration of 10μM of norepinephrine inhibited significantly (p≤0.05), cell migration and invasion of SCC-9 and SCC-25, being the most pronounced effect in SCC-25 cells. Furthermore, there was a significant reduction (p≤0.05) of norepinephrine effect on cell migration when the β2-AR was inhibited by propranolol. In addition, blockade of β-ARs by propranolol partially reversed the effect of norepinephrine on the invasiveness of SCC-9 and SCC-25. These results show that norepinephrine via β2-AR activation, reduced the migration and invasion of oral squamous cell carcinoma cells and, therefore, the use of beta-adrenergic receptors agonists could become an adjuvant therapeutic target in the treatment of this malignancy...

Migração e invasão do câncer de boca via ativação de receptor beta 2 adrenérgico por mediador do estresse / Cell migration and invasion of oral cancer via activation of beta 2 adrenergic receptor by stress mediator

A ativação do receptor beta 2 adrenérgico (β2-AR), pelos mediadores químicos do estresse, pode induzir efeitos estimuladores ou inibidores na migração e invasão celular, dependendo do tipo de tumor maligno. A importância deste receptor na evolução do câncer de boca não está totalmente esclarecida. O objetivo deste estudo foi verificar a expressão do β2-AR em linhagens de carcinomas espinocelular de boca (SCC-9 e SCC-25), e investigar o papel da ativação deste receptor pela norepinefrina e de seu bloqueio por um antagonista na migração e invasão destas células neoplásicas. As células SCC-9 e SCC-25 foram investigadas quanto à expressão gênica e proteica do β2-AR, respectivamente, pelo RT-qPCR e pelo Western blot. A migração e a invasão celular foram analisadas pelo ensaio de cicatrização de feridas e pelo sistema de câmeras de invasão Transwell, respectivamente. Diferentes concentrações (0,1; 1 e 10μM) de norepinefrina foram utilizadas para estimular e 1μM de propranolol foi empregado para bloquear os receptores beta adrenérgicos nas células neoplásicas. As diferenças das médias obtidas nos experimentos de invasão e migração de SCC-9 e SCC-25 e da expressão proteica do β2-AR, foram comparadas pelo teste t de Student com nível de significância de 5%. Os resultados mostraram que a expressão gênica e proteica do β2-AR foi verificada em ambas as linhagens de câncer de boca. A concentração de 10μM de norepinefrina inibiu, significativamente (p≤0,05), a migração e invasão celular de SCC-9 e SCC-25, sendo este efeito mais acentuado nas células SCC-25. Além disso, houve uma redução significativa (p≤0,05) do efeito da norepinefrina na migração celular quando os β2-AR foram inibidos pelo propranolol. Adicionalmente, o bloqueio dos β-ARs pelo propranolol reverteu parcialmente o efeito da norepinefrina na capacidade invasiva de SCC-9 e SCC-25. Estes resultados comprovam que a norepinefrina, via ativação do β2-AR, reduziu a migração e a invasão das...

The activation of beta 2 adrenergic receptor (β2-AR), by chemical mediators of stress, can induce stimulatory or inhibitory effects on cell migration and invasion, depending on the type of malignancy. The importance of this receptor in the oral cancer outcome is not fully understood. The aim of this study was to verify β2- AR expression in oral squamous cell carcinoma cell lines (SCC-9 and SCC-25), and to investigate the role of activation of this receptor by norepinephrine and its blockade by an antagonist in migration and invasion of these neoplastic cells. SCC-9 and SCC-25 cells were investigated for gene and protein expression of β2-AR, respectively, by RT-qPCR and Western blot. The cell migration and invasion were analyzed by wound healing assay and Transwell invasion camera system, respectively. Different concentrations (0.1, 1 and 10μM) of norepinephrine were used to stimulate and 1μM propranolol was used to block the beta adrenergic receptors on cancer cells. Differences in mean values of the invasion and migration assays of SCC-9 and SCC-25 and β2-AR protein expression were compared by the Student t test with 5% significance level. The results showed that β2-AR gene and protein expression was verified in both oral cancer cell lines. The concentration of 10μM of norepinephrine inhibited significantly (p≤0.05), cell migration and invasion of SCC-9 and SCC-25, being the most pronounced effect in SCC-25 cells. Furthermore, there was a significant reduction (p≤0.05) of norepinephrine effect on cell migration when the β2-AR was inhibited by propranolol. In addition, blockade of β-ARs by propranolol partially reversed the effect of norepinephrine on the invasiveness of SCC-9 and SCC-25. These results show that norepinephrine via β2-AR activation, reduced the migration and invasion of oral squamous cell carcinoma cells and, therefore, the use of beta-adrenergic receptors agonists could become an adjuvant therapeutic target in the treatment of this malignancy.

Effect of Alpha-1-Adrenergic Agonist, Midodrine for the Management of Long-Standing Neurogenic Shock in Patient with Cervical Spinal Cord Injury: A Case Report / 대한신경손상학회지

We report a rare case of a 71-year-old male patient who had suffered from long-lasting neurogenic shock for 13 weeks after cervical spinal cord injury (SCI) caused by a bicycle accident. The neurogenic shock was resolved dramatically 2 weeks after the administration of alpha-1-adrenergic agonist, midodrine hydrochloride. In usual cases, neurogenic shock tends to improve between 2 and 6 weeks after SCI; however, in a few cases, the shock lasts for several months. In our case, spinal shock lasted for 13 weeks and exhibited very sensitive decline of blood pressure for even a slight decrease of dopamine despite recovered bulbospongiosus reflex. Three days after midodrine hydrochloride was added, hypotension improved dramatically. We discuss our rare case with pertinent literatures.

Unsupported conclusions in the article "Synephrine-containing dietary supplement precipitating apical ballooning syndrome in a young female"

No abstract available.

Comparative study of nitric oxide production induced by selective estrogen receptors alpha and beta agonists in rats / Comparação da produção de óxido nítrico mediada por agonistas seletivos de receptores estrogênicos alfa e beta em ratos

BACKGROUND AND OBJECTIVES: Nitric oxide (NO) is a potent vasodilator and estrogen-mediated vasodilation that increases NO production. The association of the vascular endothelium, gender and vasodilation induced by estrogen is due to the activation of two estrogen receptors, alpha (ERa) and beta (ERb). The aim of this study was to compare NO production stimulating receptors ERa and ERb with the use of selective agonists in thoracic aortas of rats. METHODS: Aortic rings were either treated with 17 ?-estradiol (17-BE2); acetylcholine (Ach); 4,4',4-[4-propil-(1H)-pirazol-1,3,5-triyl]tris-phenol (PPT), and 2,3-Bis(4-hydroxyphenyl)-propionitrile (DPN), or left untreated, and the concentration of NO was determined by spectrophotometry method. RESULTS: The females presented a higher basal concentration of nitrite than males. PPT determined increased production of nitrite in both females and males, compared to17-beta-estradiol (17-BE2). In males, the production of nitrite induced by DPN and PPT was higher than that induced by 17-BE2. The stimulation with 17-BE2 increased the production of nitrite in females compared to males. Regardless the gender, the stimulation of aortic rings by PPT caused a greater production of nitrite compared to that induced by 17-BE2. Interestingly, the stimulation of aortic rings from males with DPN provided an increase in the nitrite production compared to the levels induced by 17-BE2 incubation. CONCLUSION: The stimulation of estrogen receptor (ER) by PPT provides greater production of nitrite than 17-BE2 regardless of gender; in males, the stimulation of ER by DPN provides bigger production of nitrite than 17-BE2; the basal production of nitrite is higher in females compared to males.

JUSTIFICATIVA E OBJETIVOS: O óxido nítrico (NO) é um potente vasodilatador e o estrógeno promove vasodilatação aumentando a produção de NO. A associação entre endotélio vascular, gênero e vasodilatação induzida pelo estrógeno, é pela ativação de receptores estrogênicos, alfa (ERa) e (beta) ERb.O objetivo deste estudo foi comparar a produção de NO estimulando receptores estrogênicos, ERa e ERb, por agonistas seletivos em aorta torácica de ratos. MÉTODOS: Anéis aórticos foram tratados com 17 ?-estradiol (17-BE2), acetilcolina (Ach), 4,4',4-[4-propil-(1H)-pirazol-1,3,5-triyl]tris-fenol (PPT) e 2,3-Bis(4-hidroxifenil)-propionitrila (DPN) ou não tratados e a determinação de NO foi feita por método espectrofotométrico. RESULTADOS: As fêmeas apresentaram produção constitutiva basal de nitrito mais elevada do que os machos. O PPT causou elevação na produção de nitrito em ambos os sexos, em relação ao observado com 17-beta estradiol (17-BE2). Nos machos, PPT e DPN, aumentaram a produção de nitrito comparada àquela induzida por 17-BE2.A estimulação com 17-BE2 causou maior produção de nitrito em fêmeas que em machos. A incubação com PPT determinou maior produção de nitrito comparada àquela induzida por 17-BE2, independente do gênero. Interessantemente, em machos,a estimulação das artérias com DPN acarretou em elevação na produção de nitrito comparada ao efeito causado por 17-BE2.CONCLUSÃO: A estimulação de receptor estrogênico (ER) pelo PPT determina maior produção de nitrito do que 17-BE2 independente do gênero; a estimulação de ER pelo DPN determina maior produção de nitrito do que 17-BE2 em machos; a produção basal de nitrito é mais elevada em fêmeas comparada aos machos.

Synephrine-containing dietary supplement precipitating apical ballooning syndrome in a young female

Apical ballooning syndrome (ABS) is a unique reversible cardiomyopathy that is frequently precipitated by emotional or physical stress. In addition, the few drugs reported to precipitate ABS were either illegal or strictly controlled for medical use. This paper reports a case of ABS precipitated by a dietary supplement. Our case accentuates the potential risk of dietary supplements containing synephrine, which is uncontrolled and available to the general public. Therefore, the Korea Food and Drug Administration should regulate these dietary supplements, and warn healthcare workers and the general public of the potential hazards of the indiscriminate abuse of dietary supplements.

Evaluación de la efectividad y seguridad de los alfa agonistas para déficit atencional en población entre 6 y 19 años: revisión sistemática / Effectiveness and safety of alpha agonists for ADHD in population between 6 and 19 years: a systematic review

Introducción: el trastorno por déficit de atención e hiperactividad (TDAH) dispone de intervenciones farmacológicas y los psicoestimulantes son de primera opción; también se han usado otras alternativas como los alfa agonistas (clonidina), de las que es importante conocer su efectividad y seguridad. Objetivo: identificar, sintetizar y evaluar la mejor evidencia disponible sobre la efectividad y seguridad de los alfa agonistas en el tratamiento en déficit atencional en la población de 6 a 19 años. Métodos: se realizó una revisión sistemática de estudios de intervenciones, que evaluaron efectividad comparada entre alfa agonistas y metilfenidato, que se midió en términos de funcionamiento educacional, funcionamiento psicosocial, calidad de vida y efectos adversos, en las siguientes bases de datos hasta febrero de 2012 en inglés y castellano: PubMed, Lilacs, Cochrane, DARE y Guideline. Los artículos que cumplieron con criterios de inclusión, fueron evaluados por dos investigadores en forma independiente. Resultados: de los 34 estudios encontrados inicialmente, se incluyeron 3, entre ellos una revisión sistemática y 2 guías clínicas. Conclusiones: la clonidina puede ser un tratamiento eficaz de segundo y tercer nivel para los síntomas de TDAH, pero tiene un efecto menor que el de los estimulantes. Su uso se asocia con muchos efectos secundarios.

Introduction: Attention deficit hyperactivity disorder (ADHD) is generally treated with pharmacological interventions; psychostimulants are first choice. Other alternatives have been used such as alpha agonists (clonidine), hence it is important to know its effectiveness and safety. Purpose: To identify, synthesize and evaluate the best available evidence on the effectiveness and safety of alpha agonists in treating ADHD in the 6-19 year-old population. Methods: A systematic review of intervention studies that evaluated effectiveness comparing alpha agonists to methylphenidate was conducted. Outcomes measured were educational performance, psychosocial functioning, quality of life and adverse effects. The following databases were searched up to February 2012 in English and Spanish: PubMed/MEDLINE, Lilacs, Cochrane, DARE and National Guideline Clearinghouse. The articles that met the inclusion criteria were assessed by two researchers independently. Results: Of the 34 studies found initially, three were included, among which a systematic review and two clinical guidelines. Conclusions: Clonidine is considered an effective second and third line treatment for ADHD symptoms, but it is less effective than stimulants. Its use is associated with many side effects.

A eficácia da terlipressina versus adrenalina na ressuscitação cardiopulmonar em suínos / The efficacy of terlipressin versus adrenaline in swine cardiopulmonary resuscitation / La eficacia de la terlipresina versus adrenalina en la resucitación cardiopulmonar en cerdos

JUSTIFICATIVA E OBJETIVOS: O objetivo deste estudo foi avaliar a eficácia da terlipressina (TP) versus adrenalina (ADR) em aumentar a pressão de perfusão coronariana (PPC) e o retorno da circulação espontânea (RCE) na RCP em suínos. MÉTODOS: Sob anestesia cetamina/tiopental, induziu-se fibrilação ventricular em 44 porcos fêmeas imaturos, permanecendo não assistida por 10 min, seguidos de 2 min de RCP-manual (100 compressões/10 ventilações/min com ar). Os animais foram então alocados em quatro grupos, recebendo: 1) ADR (45 µg.kg-1); 2) salina-placebo (10 mL); 3) TP (20 µg.kg-1); 4) TP (20 µg.kg-1) + ADR (45 µg.kg-1). Desfibrilação foi realizada 2 min após, observando-se os animais sobreviventes por um período de 30 min. ECG, PA sistêmica, PAD e PetCO2 foram monitorados continuamente. RESULTADOS: A TP não diferiu do placebo quanto aos efeitos na PPC, com baixas taxas de RCE em ambos os grupos (1/11 vs.2/11; p = NS). A ADR aumentou a PPC de 13 ± 12 para 54 ± 15 mmHg (p < 0,0001), efeito similar a TP + ADR (de 21 ± 10 para 45 ± 13 mmHg; p < 0,0001), com altas taxas de RCE/sobreviventes em ambos os grupos (10/11 vs.9/11, respectivamente). Entre os sobreviventes, maior PAM foi observada no grupo TP + ADR vs.ADR (105 ± 19 mmHg vs.76 ± 21 mmHg; p = 0,0157). CONCLUSÕES: ADR e TP + ADR foram efetivas para aumentar a PPC/RCE neste modelo experimental, mas a TP, isolada, não foi diferente do placebo. Contudo, nos animais sobreviventes do grupo TP + ADR observou-se maior estabilidade hemodinâmica após a RCE, sugerindo que a TP possa ser uma medicação útil no manuseio da hipotensão pós-RCP.

BACKGROUND AND OBJECTIVES: The objective of the present study was to evaluate the efficacy of terlipressin (TP) vs.adrenaline (ADR) in increasing coronary perfusion pressure (CPP) and return of spontaneous circulation (ROSC) in swine CPR. METHODS: Under anesthesia with ketamine/thiopental, ventricular fibrillation was induced in 44 female immature pigs, remaining unassisted for 10 minutes, followed by 2 minutes of manual CPR (100 compression/10 ventilations/min with air). Animals were, then, divided into four groups: 1) ADR (45 µg.kg-1); 2) saline-placebo (10 mL); 3) TP 20 µg.kg-1); and TP (20 µg.kg-1) + ADR (45 µg.kg-1). Defibrillation was performed after 2 minutes, observing surviving animals for a 30-minute period. Electrocardiogram, systemic BP, DBP, and PetCO2 were monitored continuously. RESULTS: Terlipressin did not differ from placebo regarding the effects on CPP, with low rates of ROSC in both groups (1/11 vs.2/11; p = NS). Adrenaline increased CPP from 13 ± 12 to 54 ± 15 mmHg (p < 0.0001), similar effect to TP + ADR (from 21 ± 10 to 45 ± 13 mmHg; p < 0.0001), with high rates of ROSC/survivors in both groups (10/11 vs.9/11, respectively). Among survivors, greater MAP was observed in the TP + ADR group vs.ADR (105 ± 19 mmHg vs.76 ± 21 mmHg; p = 0.0157) groups. CONCLUSIONS: Adrenaline and TP + ADR were effective on maintaining CPP/ROSC in this experimental model, but isolated TP did not differ from placebo. However, in surviving animals in the TP + ADR group, greater hemodynamic stability was observed after ROSC, suggesting that TP can be a useful medication in the management of post-CPR hypotension.

JUSTIFICATIVA Y OBJETIVOS: El objetivo de este estudio fue evaluar la eficacia de la terlipresina (TP) versus adrenalina (ADR) en aumentar la presión de perfusión coronaria (PPC) y el retorno de la circulación espontánea (RCE) en la RCP en cerdos. MÉTODOS: Bajo la anestesia ketamina/tiopental, se indujo la fibrilación ventricular en 44 cerdos hembras no adultos, permaneciendo no asistida por 10 min, seguidos de 2 min de RCP-manual (100 compresiones/10 ventilaciones/min con aire). Los animales se ubicaron entonces en cuatro grupos, recibiendo: 1) ADR (45 µg.kg-1); 2) salina-placebo (10 mL); 3) TP (20 µg.kg-1); 4) TP (20 µg.kg-1) + ADR (45 µg.kg-1). La desfibrilación fue realizada 2 min después, haciendo el seguimiento de los animales sobrevivientes por un período de 30 min. ECG, PA sistémica, PAD y PetCO2 fueron monitorizados continuamente. RESULTADOS: La TP no fue diferente del placebo en cuanto a los efectos en la PPC, con bajas tasas de RCE en ambos grupos (1/11 vs.2/11; p = NS). La ADR aumentó la PPC de 13 ± 12 para 54 ± 15 mmHg (p < 0,0001), efecto similar a TP + ADR (de 21 ± 10 para 45 ± 13 mmHg; p < 0,0001), con altas tasas de RCE/supervivientes en ambos grupos (10/11 vs.9/11, respectivamente). Entre los supervivientes, se observó una mayor PAM en el grupo TP + ADR vs.ADR (105 ± 19 mmHg vs.76 ± 21 mmHg; p = 0,0157). CONCLUSIONES: La ADR y TP + ADR fueron efectivas para aumentar la PPC/RCE en este modelo experimental, pero la TP aislada, no fue diferente del placebo. Sin embargo, en los animales supervivientes del grupo TP + ADR, vimos una mayor estabilidad hemodinámica después de la RCE, lo que nos indica que la TP puede ser una medicación útil en el manejo de la hipotensión post-RCP.

Estudo sobre os fatores relacionados a interrupção do tratamento do glaucoma / Study of the factors related to stop the treatment of glaucoma

OBJETIVO: Identificar causas relacionadas com a não aderência ao tratamento do glaucoma primário de ângulo aberto e sugerir meios para posteriormente minimizá-las. MÉTODOS: Foi aplicado um questionário a pacientes portadores de glaucoma primário de ângulo aberto no Hospital Universitário Gaffrée e Guinle, escolhidos aleatoriamente, para avaliação dos fatores relacionados com a interrupção do tratamento. Para isso, utilizou-se uma análise univariada, pelo teste exato de Fisher, e considerou estatisticamente significativo p<0,05. RESULTADOS: A partir do questionário, identificou-se dois subgrupos, um que já havia interrompido o tratamento e outro que nunca o havia interrompido, compostos por 25 e 11 pacientes respectivamente. Estes grupos foram comparados entre si e todos os parâmetros analisados. O custo dos medicamentos (p=0,001) e o fator esquecimento (p=0,007) foram estatisticamente relevantes para a interrupção do tratamento da doença. As demais variáveis testadas não obtiveram significância estatística. CONCLUSÃO: O custo dos medicamentos e o fator esquecimento foram os fatores mais importantes para interrupção do tratamento.

The objective was to identify causes related to noncompliance of primary open-angle glaucoma and suggest ways to minimize them later. A questionnaire was given to patients with primary open angle glaucoma in Hospital Gaffrée Guinle, chosen randomly, to assess factors related to discontinuation of treatment. For this we used a univariate analysis by Fisher's exact test and considered statistically significant p <0.05. From the questionnaire, we identified two sub-groups, who had stopped treatment and another who had never stopped for 25 compounds and 11 patients respectively. These groups were compared, and all parameters examined. The cost of drugs (p = 0.001) and forgetting factor (p = 0.007) were statistically significant for discontinuation of treatment of disease. The other variables tested did not achieve statistical significance. CONCLUSION: The cost of drugs and forgetting to take medication were the factors most important to withholding treatment.

Larval settlement and spat recovery rates of the oyster Crassostrea brasiliana (Lamarck, 1819) using different systems to induce metamorphosis / Taxas de assentamento larval e recuperação de sementes da ostra Crassostrea brasiliana (Lamarck, 1819) com uso de diferentes sistemas de indução à metamorfose

This study aimed at the assessment, in the laboratory, of the larval settlement and spat recovery rates of oysters of the species Crassostrea brasiliana using plastic collectors, epinephrine (C9H13NO3 C4H6O6) and shell powder in settlement tanks. Polypropylene was used attached to bamboo frames. The material was chosen due to its pliability - that favours the spat detachment. Two experiments were carried out; the first between February and April 2008, and the second between November and December 2008 at the Marine Mussel Laboratory of Santa Catarina Federal University (Laboratório de Moluscos Marinhos da Universidade Federal de Santa Catarina). In the first experiment, the scratched plastic collectors were tested consorting them with shell powder; on the second, the plastic collectors were tested consorted with shell powder, only shell powder and epinephrine as the metamorphosis stimulator. The quantification was carried out of the larvae settled in the plastic collectors, and of the recovery and integrity of the spats after their detachment. The first experiment has shown a recovery rate of 48.83 percent of the spats in comparison with the D larvae used. From this percentage, 4.9 percent settled in the plastic collectors and 43.93 percent in shell powder. The second experiment revealed 55.78 percent regarding the settled spats in comparison with the total of larvae used (using epinephrine), 78.62 percent in the treatment with the collector plus shell powder and 58.33 percent in the treatment only with shell powder. Thus, the use of the collector plus shell powder resulted in a greater spat recovery when compared to the other treatments.

O presente estudo teve como objetivo avaliar a taxa de assentamento larval e recuperação de sementes de ostras da espécie Crassostrea brasiliana, em laboratório, através do uso de coletores plásticos, epinefrina (C9H13NO3 C4H6O6) e pó de concha em tanques de assentamento. Foram utilizados coletores plásticos de polipropileno, presos a armações de bambu. O material foi escolhido devido à boa maleabilidade, o que facilita o destacamento das sementes. Foram realizados dois experimentos, o primeiro entre fevereiro e abril de 2008, e o segundo entre novembro e dezembro de 2008 no Laboratório de Moluscos Marinhos da Universidade Federal de Santa Catarina. No primeiro experimento, testaram-se coletores de plástico arranhado consorciado com pó de concha em um tanque de assentamento, enquanto que no segundo foram utilizados dois tanques de assentamento, um contendo os coletores de plástico consorciado com pó de concha e apenas pó de concha, e, no outro tanque, utilizou-se epinefrina como estimulador da metamorfose. Foi realizada a quantificação das larvas assentadas nos coletores plásticos e a taxa de recuperação e integridade das sementes após o destacamento. No primeiro experimento, recuperaram-se 48,83 por cento de sementes em relação às larvas D utilizadas. Deste percentual, 4,9 por cento assentaram em coletores plásticos e 43,93 por cento em pó de concha. No segundo experimento, a porcentagem de sementes assentadas em relação ao total de larvas utilizadas foi de 55,78 por cento com o uso de epinefrina, 78,62 por cento no tratamento com coletor mais pó de concha e de 58,33 por cento no tratamento só com pó de concha. Assim, verifica-se que o uso de coletor mais pó de concha resulta em maior recuperação de sementes se comparado com os demais tratamentos.

Dexmedetomidine as an adjunct to anesthetic induction to attenuate hemodynamic response to endotracheal intubation in patients undergoing fast-track CABG.

During induction of general anesthesia hypertension and tachycardia caused by tracheal intubation may lead to cardiac ischemia and arrhythmias. In this prospective, randomized study, dexmedetomidine has been used to attenuate the hemodynamic response to endotracheal intubation with low dose fentanyl and etomidate in patients undergoing myocardial revascularization receiving beta blocker treatment. Thirty patients undergoing myocardial revascularization received in a double blind manner, either a saline placebo or a dexmedetomidine infusion (1 µg/kg) before the anesthesia induction. Heart rate (HR) and blood pressure (BP) were monitored at baseline, after placebo or dexmedetomidine infusion, after induction of general anesthesia, one, three and five minutes after endotracheal intubation. In the dexmedetomidine (DEX) group systolic (SAP), diastolic (DAP) and mean arterial pressures (MAP) were lower at all times in comparison to baseline values; in the placebo (PLA) group SAP, DAP and MAP decreased after the induction of general anesthesia and five minutes after the intubation compared to baseline values. This decrease was not significantly different between the groups. After the induction of general anesthesia, the drop in HR was higher in DEX group compared to PLA group. One minute after endotracheal intubation, HR significantly increased in PLA group while, it decreased in the DEX group. The incidence of tachycardia, hypotension and bradycardia was not different between the groups. The incidence of hypertension requiring treatment was significantly greater in the PLA group. It is concluded that dexmedetomidine can safely be used to attenuate the hemodynamic response to endotracheal intubation in patients undergoing myocardial revascularization receiving beta blockers.

Infarto perioperatorio en cirugía no-cardíaca y dexmedetomidina / Perioperative myocardical infaction in non-cardiac surgery and dexmedetomidine

La patología cardiovascular es la primera causa de muerte en Chile y en el mundo. Desde el punto de vista quirúrgico, anestesiólogos y cirujanos enfrentan más frecuentemente pacientes mayores con patología cardiovascular. La incidencia de isquemia miocárdica en pacientes de alto riesgo, sometidos a cirugía no-cardíaca, es cercana al 40 por ciento durante el perioperatorio. La incidencia de infarto miocárdico y muerte en cirugía no-cardíaca, oscila entre 1 y 5 por ciento. Existe una estrecha relación entre los eventos isquémicos perioperatorios y el aumento de la morbimortalidad cardiovascular. Por este motivo, se han desarrollado medidas terapéuticas orientadas a disminuir la incidencia de isquemia perioperatoria y aminorar el daño asociado a ella. La adecuada identificación de pacientes de riesgo, la optimización del tratamiento médico de patologías asociadas y el uso de fármacos cardioprotectores durante el perioperatorio, han mostrado disminuir la incidencia de complicaciones cardíacas. Dexmedetomidina es un agonista beta2-adrenérgico de uso frecuente en anestesia. La evidencia sugiere que posee propiedades cardioprotectoras que podrían beneficiar a pacientes quirúrgicos de alto riesgo cardiovascular. La cardioprotección conferida por dexmedetomidina estaría mediada por la modulación del sistema nervioso autónomo. La disminución de la frecuencia cardíaca y de la presión arterial observada durante su uso, evitarían el desbalance entre aporte y demanda de oxígeno miocárdico y atenuarían el estrés sobre placas ateromatosas inestables. Hasta este momento se desconoce si dexmedetomidina produce precondicionamiento cardíaco y si activa vías transduccionales asociadas a cardioprotección. Frente a la actual realidad epidemiológica en Chile y el mundo, es importante estudiar y definir, cuales son los fármacos de uso frecuente en anestesia con capacidad cardloprotectora y los mecanismos Involucrados en esta protección. Sería Interesante lograr...

Cardiovascular disease is the leading cause of death In Chile and worldwide. Anesthesiologists and surgeons often face more elderly surgical patients with cardiovascular disease. The incidence of myocardial Ischemia in patents at high risk, undergoing non-cardiac surgery is about 40 percent during the perioperative period. The incidence of myocardial Infarction and death in non-cardiac surgery is between 1 and 5 percent. There is a close relationship between perioperative Ischemic events and increased cardiovascular morbidity and mortality Therefore, therapeutic approaches have been developed to reduce the Incidence of perioperative Ischemia and lessen the damage associated with it. The proper Identification of patients at risk, optimizing the medical treatment of associated diseases and the use of cardioprotective drugs during the perioperative period have shown to decrease the Incidence of cardiac complications. The beta2-adrenergic agonist dexmedetomidine is commonly used in anesthesia. The evidence suggests that possesses cardioprotective properties that could benefit surgical patients at high cardiovascular risk. The cardioprotection conferred by dexmedetomidine would be mediated by modulation of the autonomic nervous system. The decrease in heart rate and blood pressure observed during its use could avoid the Imbalance between supply and myocardial oxygen demand and lessen the stress on unstable athermanous plaques. So far it is unknown whether dexmedetomidine produces cardiac preconditioning by activating cardioprotective-signaling pathways. Faced with the current worldwide epidemiologic situation, It would be Important to study the cardioprotective capacity of drugs frequently used in anesthesia and the mechanisms Involved In that protection. It would be interesting to achieve that definition regarding the perioperative use of dexmedetomidine.

Use of dexmedetomidine as the main anesthetic agent in patients with laryngo-tracheomalacia. A case report

The successful use of Dexmedetomidine as the main anesthetic agent for three pediatric patients with tracheomalacia presenting for different kinds of urgent operations is described. Patients were kept spontaneously breathing without intubation during their whole procedures. Surgical conditions were adequate, and hemodynamic and respiratory profiles were within baseline limits

Effect of dexmedetomidine on bispectral index and auditory evoked potential index during anesthesia with target controlled infusion of propofol and remifentanyl / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To evaluate the effect of dexmedetomidine (Dex) on bispectral index (BIS) and auditory evoked potential index (AAI) during anesthesia with target controlled infusion (TCI) of propofol and remifentanyl.</p><p><b>METHODS</b>Thirty adult patients (ASA I approximate, equalsII) who were scheduled for elective thyroidectomy were monitored with BIS, AAI, ECG, blood pressure, end-tidal CO(2), and pulse oximeter before and during anesthesia. Anesthesia was induced by TCI with propofol 4 mg/L and remifentanyl 1 mu g/kg. After loss of consciousness the patients were intubated after rocuronium 0.6 mg/kg intravenous injection, remifentanyl was then infused at 0.2 microg/(kg x min)(-1) and propofol infusion (Ct) was titrated to maintain a BIS value at 50 +/- 3. At 10 min after stabilization of anesthesia the patients were randomly and double-blindly divided into 2 groups: Group D (n=15) received Dex 0.4 mu g/kg iv administered over 5 min and Group C (n=15) received equal volume of normal saline. Values of BIS, AAI, MAP, HR were recorded every 2 min within 20 min after the administration of the drugs.</p><p><b>RESULTS</b>Before anesthesia the BIS index was 90 +/- 2 in Group D and 92 +/- 2 in Group C, AAI was 81 +/- 1 in Group D and 78 +/- 1 in Group C. In anesthesia with target controlled infusion of propofol, BIS index showed a significant decrease with the i.v. administration of Dex 0.4 microg/kg, while AAI remained unchanged. In Group C, both of BIS and AAI remained unchanged after saline injection.</p><p><b>CONCLUSION</b>During propofol and remifentanyl anesthesia, after the administration of Dex, BIS value demonstrates a predominant decrease, whereas AAI shows no changes.</p>