From lip to lab: salty tasting skin is the main clue that raises clinical suspicion of cystic fibrosis in young infants.

AIM: This study developed a clinical decision rule (CDR) to rule in or rule out cystic fibrosis (CF) in the first weeks of life. METHODS: We combined a two-step nonconcurrent birth cohort and a cross-sectional controlled study in which observers and mothers were blinded to confirmatory sweat test results. Neonates from uncomplicated pregnancies and deliveries, with two subsequent tests for immunoreactive trypsinogen (IRT) higher than 70 ng/mL, were eligible to take part. RESULTS: We included 49 CF-affected and 177 CF-unaffected infants with an average age of 34 days. CF-affected infants demonstrated statistically significant differences in weight gain, stool frequency and salty tasting skin from birth. Multivariate analysis showed that the main predictors of CF were salty tasting skin (odds ratio 17.2) and weight gain of <10.5 g per day (odds ratio 4.6). Depending on the CDR score, we obtained the following results: sensitivity (42.9-61.2%), specificity (89.6-96.5%), positive (62.5-77.8%) and negative (85.6-89.1%) predictive value and positive (5.8-12.3) and negative (0.4-0.6) likelihood ratio. CONCLUSION: The CDR could provide a reliable index of clinical suspicion and timely referral for sweat testing in settings without newborn screening programmes and may also be applied to false-negative individuals where such programmes already exist.

Toxicologia e profissionais de saúde: uso abusivo e dependência / Toxicology and health professionals: drug abuse and dependence

Na década de 1990, foi demonstrada alta prevalência no uso abusivo de opioides pelos anestesiologistas. Desde então, houve aumento nas pesquisas desse tipo de comportamento entre os profissionais da área de saúde. No entanto, observa-se aumento da prevalência da dependência de drogas entre esses profissionais, devido a várias situações como: estresse, extensas jornadas de trabalho e o fácil acesso aos medicamentos. Outros fatores envolvidos estão relacionados a aspectos bioquímicos, genéticos e psiquiátricos. Objetivo: discutir a real prevalência, a etiologia e as estratégias de controle no abuso de propofol, opioides e cetamina entre os profissionais da saúde, especialmente entre as especialidades médicas. Métodos: revisão de artigos científicos disponíveis nos bancos de dados do Pubmed e Scielo. Resultados: entre os profissionais de saúde, a prevalência da dependência química de propofol, opioides (principalmente fentanil e sufentanil) e cetamina é mais alta entre os anestesiologistas, médicos socorristas e psiquiatras. Foi encontrada considerável associação entre a dependência química desses profissionais e outras psicopatogenias, como transtornos de personalidade e depressão. Esses transtornos podem até mesmo influenciar a escolha da droga utilizada. Conclusão: apesar do aumento do número de dependentes químicos em propofol, opioides e cetamina entre os profissionais da saúde, existem poucas estratégias de controle para impedir o acesso a esses medicamentos para uso próprio. Além disso, há poucas informações sobre a segurança do profissional em relação ao retorno ao ambiente de trabalho após o período de reabilitação.

A high prevalence of opioid abuse was found among anesthesiologists in the 1990s. Ever since, an increased number of studies have focused on health professionals? behaviors. However, the prevalence of drug abuse has increased among these professionals as a result of: stress, long work hours, and easy access to the drugs. Other factors involved are of biochemical, genetic and psychiatric nature. Objective: To discuss the actual prevalence, etiology and control strategies related to propofol, opioid and ketamine abuse among health professionals, particularly specialist physicians. Methods: Review of academic articles available on Pubmed and Scielo databases. Results: The prevalence of chemical dependence on propofol, opioids (specially fentanyl and sufentanil) and ketamine is higher among the anesthesiologists, paramedics, and psychiatrists. A meaningful correlation was found between these professionals? chemical dependence and other psychopathologies, including personality disorder, and depression. Such disorders may.