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1.
Biomedica ; 43(1): 22-26, 2023 03 30.
Article in English, Spanish | MEDLINE | ID: mdl-37167469

ABSTRACT

Pyogenic liver abscesses due to Granulicatella adiacens are infections associated with high mortality, mainly in immunocompromised patients. The main microorganisms associated with liver abscesses are Klebsiella pneumoniae, and Escherichia coli, though it may also be polymicrobial. However, case reports describing liver infection by Granulicatella adiacens are scarce. We present the case of an immunocompetent adult patient who presented 15 days of evolution consisting of quantified fever peaks associated with asthenia, adynamia, chills, jaundice and coluria. The initial clinical examination revealed a generalized icteric tint without abdominal pain, and blood pressure with a tendency to hypotension. Biliopancreatic confluent neoplasia, secondary cholangitis and sepsis of biliary origin were suspected, initiating fluid resuscitation and antibiotic therapy; blood cultures and complementary diagnostic studies were taken. Hepatobiliary ultrasound with evidence of an abscess of 73 x 62 mm in segment IV; the bile duct and pancreas were within normal limits. To better characterize the lesion evidenced in the liver, a contrast-enhanced computed tomography of the abdomen was performed. The patient completed antibiotic management with ciprofloxacin, vancomycin, and metronidazole in good condition and was successfully discharged. This is the first pyogenic liver abscess reported caused by Granulicatella adiacens in an immunocompetent patient, in whom early microbiological diagnosis in conjunction with targeted antibiotic treatment and percutaneous drainage of the lesion was decisive in the clinical outcome.


Los abscesos hepáticos piógenos por Granulicatella adiacens son infecciones asociadas a una alta mortalidad, principalmente en pacientes inmunocomprometidos. Los principales microorganismos asociados a los abscesos hepáticos son Klebsiella pneumoniae y Escherichia coli, aunque pueden ser polimicrobianos. Sin embargo, los informes de casos que describen la infección hepática por G. adiacens son muy escasos. Se presenta el caso de un paciente adulto inmunocompetente que presentó 15 días de evolución de picos febriles cuantificados asociados a astenia, adinamia, escalofríos, ictericia y coluria. El examen clínico inicial reveló un tinte ictérico generalizado sin dolor abdominal, y presión arterial con tendencia a la hipotensión. Se sospechó neoplasia biliopancreática confluente, colangitis secundaria y sepsis de origen biliar, y se inició reanimación con líquidos y antibioterapia. Se tomaron hemocultivos y estudios diagnósticos complementarios. En el ultrasonido hepatobiliar, se observó un absceso de 73 x 62 mm en el segmento IV; la vía biliar y el páncreas se encontraron dentro de los límites normales. Se realizaron múltiples pruebas moleculares de detección de microorganismos (FilmArray), y se identificó a G. adiacens como el principal agente patógeno. El paciente completó el manejo antibiótico con ciprofloxacina, vancomicina y metronidazol en buenas condiciones y fue dado de alta con éxito. Este es el primer absceso hepático piógeno reportado causado por G. adiacens en un paciente inmunocompetente, en quien el diagnóstico microbiológico temprano en conjunto con el tratamiento antibiótico dirigido y el drenaje percutáneo de la lesión fueron determinantes en el resultado clínico.


Subject(s)
Carnobacteriaceae , Liver Abscess, Pyogenic , Adult , Humans , Liver Abscess, Pyogenic/etiology , Liver Abscess, Pyogenic/microbiology , Anti-Bacterial Agents/therapeutic use , Metronidazole , Escherichia coli
2.
Biomédica (Bogotá) ; 43(1): 22-26, mar. 2023.
Article in English | LILACS | ID: biblio-1533913

ABSTRACT

Pyogenic liver abscesses due to Granulicatella adiacens are infections associated with high mortality, mainly in immunocompromised patients. The main microorganisms associated with liver abscesses are Klebsiella pneumoniae, and Escherichia coli, though it may also be polymicrobial. However, case reports describing liver infection by Granulicatella adiacens are scarce. We present the case of an immunocompetent adult patient who presented 15 days of evolution consisting of quantified fever peaks associated with asthenia, adynamia, chills, jaundice and coluria. The initial clinical examination revealed a generalized icteric tint without abdominal pain, and blood pressure with a tendency to hypotension. Biliopancreatic confluent neoplasia, secondary cholangitis and sepsis of biliary origin were suspected, initiating fluid resuscitation and antibiotic therapy; blood cultures and complementary diagnostic studies were taken. Hepatobiliary ultrasound with evidence of an abscess of 73 x 62 mm in segment IV; the bile duct and pancreas were within normal limits. To better characterize the lesion evidenced in the liver, a contrast-enhanced computed tomography of the abdomen was performed. The patient completed antibiotic management with ciprofloxacin, vancomycin, and metronidazole in good condition and was successfully discharged. This is the first pyogenic liver abscess reported caused by Granulicatella adiacens in an immunocompetent patient, in whom early microbiological diagnosis in conjunction with targeted antibiotic treatment and percutaneous drainage of the lesion was decisive in the clinical outcome.


Los abscesos hepáticos piógenos por Granulicatella adiacens son infecciones asociadas a una alta mortalidad, principalmente en pacientes inmunocomprometidos. Los principales microorganismos asociados a los abscesos hepáticos son Klebsiella pneumoniae y Escherichia coli, aunque pueden ser polimicrobianos. Sin embargo, los informes de casos que describen la infección hepática por G. adiacens son muy escasos. Se presenta el caso de un paciente adulto inmunocompetente que presentó 15 días de evolución de picos febriles cuantificados asociados a astenia, adinamia, escalofríos, ictericia y coluria. El examen clínico inicial reveló un tinte ictérico generalizado sin dolor abdominal, y presión arterial con tendencia a la hipotensión. Se sospechó neoplasia biliopancreática confluente, colangitis secundaria y sepsis de origen biliar, y se inició reanimación con líquidos y antibioterapia. Se tomaron hemocultivos y estudios diagnósticos complementarios. En el ultrasonido hepatobiliar, se observó un absceso de 73 x 62 mm en el segmento IV; la vía biliar y el páncreas se encontraron dentro de los límites normales. Se realizaron múltiples pruebas moleculares de detección de microorganismos (FilmArray), y se identificó a G. adiacens como el principal agente patógeno. El paciente completó el manejo antibiótico con ciprofloxacina, vancomicina y metronidazol en buenas condiciones y fue dado de alta con éxito. Este es el primer absceso hepático piógeno reportado causado por G. adiacens en un paciente inmunocompetente, en quien el diagnóstico microbiológico temprano en conjunto con el tratamiento antibiótico dirigido y el drenaje percutáneo de la lesión fueron determinantes en el resultado clínico.


Subject(s)
Liver Abscess, Pyogenic , Case Reports
3.
Biomedica ; 42(2): 218-223, 2022 06 01.
Article in English, Spanish | MEDLINE | ID: mdl-35867915

ABSTRACT

Introduction: Multiple adverse effects have been described for the biological therapy in autoimmune diseases including many secondary to immunosuppression producing bacterial, fungal, or viral infections. Clinical case: We present the case of a 64-year-old female patient with proven disseminated cryptococcosis secondary to the use of tofacitinib. Other possible causes of immunosuppression such as the human immunodeficiency virus (HIV) were ruled out. The patient had been in treatment for rheumatoid arthritis diagnosed three years before. This drug is a biological agent that inhibits JAK enzymes. Very few cases of pulmonary and meningeal cryptococcosis in this type of patient have been described in the literature. Conclusion: This case report should be useful for other clinicians to bear in mind the possibility of this type of invasive fungal infection associated with biological therapy and to take a risk-management approach.


Introducción. Se han descrito múltiples efectos adversos con el uso de la terapia biológica para enfermedades autoinmunitarias, muchos de ellos secundarios al estado de inmunosupresión, como las infecciones bacterianas, fúngicas o virales. Caso clínico. Se presenta el caso de una mujer de 64 años con diagnóstico comprobado de criptococosis diseminada secundaria al uso de tofacitinib. Se descartaron otras causas de inmunosupresión, como infección por el virus de la inmunodeficiencia humana (HIV). Tres años antes se le había diagnosticado artritis reumatoide y se encontraba en tratamiento farmacológico con un agente biológico que inhibe las enzimas JAK. Se han descrito muy pocos casos de criptococosis pulmonar y meníngea en este tipo de pacientes. Conclusión. Este reporte de caso es útil para que otros médicos tratantes tengan presente la posibilidad de este tipo de infección fúngica invasora asociada con la terapia biológica y el enfoque de gestión de riesgo.


Subject(s)
Biological Therapy , Cryptococcosis , Cryptococcosis/diagnosis , Cryptococcosis/drug therapy , Female , Humans , Middle Aged , Retrospective Studies
4.
Biomédica (Bogotá) ; 42(2): 218-223, ene.-jun. 2022. tab, graf
Article in Spanish | LILACS | ID: biblio-1403575

ABSTRACT

Introducción. Se han descrito múltiples efectos adversos con el uso de la terapia biológica para enfermedades autoinmunitarias, muchos de ellos secundarios al estado de inmunosupresión, como las infecciones bacterianas, fúngicas o virales. Caso clínico. Se presenta el caso de una mujer de 64 años con diagnóstico comprobado de criptococosis diseminada secundaria al uso de tofacitinib. Se descartaron otras causas de inmunosupresión, como infección por el virus de la inmunodeficiencia humana (HIV). Tres años antes se le había diagnosticado artritis reumatoide y se encontraba en tratamiento farmacológico con un agente biológico que inhibe las enzimas JAK. Se han descrito muy pocos casos de criptococosis pulmonar y meníngea en este tipo de pacientes. Conclusión. Este reporte de caso es útil para que otros médicos tratantes tengan presente la posibilidad de este tipo de infección fúngica invasora asociada con la terapia biológica y el enfoque de gestión de riesgo.


Introduction: Multiple adverse effects have been described for the biological therapy in autoimmune diseases including many secondary to immunosuppression producing bacterial, fungal, or viral infections. Clinical case: We present the case of a 64-year-old female patient with proven disseminated cryptococcosis secondary to the use of tofacitinib. Other possible causes of immunosuppression such as the human immunodeficiency virus (HIV) were ruled out. The patient had been in treatment for rheumatoid arthritis diagnosed three years before. This drug is a biological agent that inhibits JAK enzymes. Very few cases of pulmonary and meningeal cryptococcosis in this type of patient have been described in the literature. Conclusion: This case report should be useful for other clinicians to bear in mind the possibility of this type of invasive fungal infection associated with biological therapy and to take a risk-management approach.


Subject(s)
Cryptococcosis , Biological Therapy , Cryptococcus neoformans , Medication Errors
5.
Front Pediatr ; 9: 726949, 2021.
Article in English | MEDLINE | ID: mdl-34552899

ABSTRACT

Endothelial insult and damage is one of the reported consequences of SARS-CoV-2 infection. It has been associated with severe inflammation, thrombotic phenomena and profound hypoxemia in critically ill patients. Endothelial activation leads to a loss of the endothelium's antithrombotic properties which, under normal conditions, are maintained by the endothelial glycocalyx, a carbohydrate-rich layer that covers the luminal surface of endothelial cells. In children, one of the serious forms of SARS-CoV-2 virus disease (COVID-19) is multisystem inflammatory syndrome (MIS-C). This new disease is characterized by a large inflammatory response and frequent cardiovascular, cutaneous and gastrointestinal disorders. We describe the first two cases of critically ill children with MIS-C who evidenced a large inflammatory response associated with elevated plasma and imaging biomarkers of endothelial activation and endothelial glycocalyx degradation. This microcirculation involvement in MIS-C could, at least partially, explain some of the clinical manifestations and laboratory and imaging alterations found in these patients. These findings contribute to a better understanding of this disease and suggest that medications to modulate the inflammatory response and protect or restore the endothelial glycocalyx should be considered in future studies.

6.
Iatreia ; 33(1): 39-58, 20200000. tab
Article in Spanish | LILACS | ID: biblio-1090531

ABSTRACT

RESUMEN El manejo adecuado de las infecciones del sitio operatorio (ISO) en neurocirugía es fundamental para la disminución de la carga de morbilidad y mortalidad en estos pacientes. La sospecha y confirmación diagnóstica asociadas al aislamiento microbiológico son esenciales para asegurar el tratamiento oportuno y el adecuado gerenciamiento de antibióticos. En esta revisión se presenta de forma resumida los puntos fundamentales para la prevención y el tratamiento de infecciones del sitio operatorio en neurocirugía y se incluye un apartado sobre el uso de antibióticos intratecales/intraventriculares.


SUMMARY The adequate management of surgical wound infections in neurosurgery is fundamental for reducing the burden of morbidity and mortality in these patients. The suspicion and diagnostic confirmation associated with microbiological isolation are essential to ensure timely treatment and proper management of antibiotics. Therefore, in this review we present, in a synthetic manner, the main points for the prevention and treatment of surgical site infections in neurosurgery, which includes a section on the use of intrathecal/intraventricular antibiotics.


Subject(s)
Humans , Surgical Wound Infection , Primary Prevention , Neurosurgery
7.
J Med Case Rep ; 13(1): 141, 2019 May 08.
Article in English | MEDLINE | ID: mdl-31064407

ABSTRACT

BACKGROUND: Carbapenem-resistant Acinetobacter baumannii infections are a major public health problem worldwide, requiring the use of "old" antibiotics such as polymyxin B and E (colistin). However, there is concern regarding the emergence of isolates resistant to these antibiotics. CASE PRESENTATION: We report a case of a 64-year-old mestizo man hospitalized in an intensive care unit of a health institution in Colombia with identification and clinical and molecular typing of a colistin- and carbapenem-resistant A. baumannii isolate with mechanisms of resistance to colistin not previously reported, causing bacteremia. CONCLUSIONS: We have identified a strain of A. baumannii with mechanisms of resistance to colistin not previously reported in a patient with bacteremia who required treatment with multiple antibiotic schemes and had an adequate response.


Subject(s)
Acinetobacter Infections/microbiology , Acinetobacter baumannii/drug effects , Anti-Bacterial Agents/pharmacology , Catheter-Related Infections/diagnosis , Colistin/pharmacology , Acinetobacter Infections/diagnosis , Acinetobacter Infections/drug therapy , Acinetobacter Infections/etiology , Acinetobacter baumannii/isolation & purification , Aged , Bacteremia/diagnosis , Bacteremia/drug therapy , Bacteremia/etiology , Bacteremia/microbiology , Catheter-Related Infections/drug therapy , Catheter-Related Infections/etiology , Catheter-Related Infections/microbiology , Catheters, Indwelling/adverse effects , Drug Resistance, Multiple, Bacterial/drug effects , Humans , Male , Middle Aged
8.
Rev. colomb. reumatol ; 25(4): 261-270, oct.-dic. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-990958

ABSTRACT

RESUMEN Objetivos: Revisar definiciones, factores asociados a adherencia, métodos para medición y determinación de adherencia a medicamentos modificadores de la enfermedad orales en artritis reumatoide. Métodos: Se realizó una búsqueda de la literatura en las bases de datos de Pubmed hasta diciembre de 2017 mediante términos MeSH (((«Arthritis, Rheumatoid¼ [Mesh] AND «Medication Adherence¼ [Mesh]) OR «Patient Compliance¼ [Mesh]) AND «Antirheumatic Agents¼ [Mesh]) de artículos que estuvieran en idioma espafñol o inglés e incluyeran solo población adulta. Resultados: De un total de 387 artículos encontrados, 43 se incluyeron para la revisión general, con información sobre definiciones de adherencia, cumplimiento, concordancia y persistencia, componentes, clasificación y dimensiones, factores de riesgo relacionados con la no adherencia al tratamiento, descripción de los métodos de medición. Solo 9 artículos midieron adherencia e incluyeron información sobre factores relacionados con adherencia a medicamentos orales en artritis reumatoide. Conclusiones: La adherencia al tratamiento farmacológico en artritis reumatoide es subóptima y se relaciona con menor efectividad en el control de la actividad inflamatoria. Los principales factores relacionados con baja adherencia incluyen problemas de acceso y disponibilidad del medicamento, mayor actividad y duración de la enfermedad, polifarmacia, uso de medicamentos por periodos prolongados, bajo estrato socioeconómico, etnia, reacciones adversas por medicamentos, percepción de inefectividad de la medicación y enfermedades concomitantes. Es necesario incorporar de forma sistemática la medición de adherencia farmacológica dentro de la práctica clínica rutinaria y la identificación de los factores de riesgo más frecuentes asociados a una baja adherencia con el fin de diseñar estrategias encaminadas a mejorar la adherencia de los pacientes y lograr mejores desenlaces clínicos.


ABSTRACT Objectives: To review the definitions, associated factors, as well as the methods for the measurement and determination of adherence to oral disease modifying drugs in rheumatoid arthritis. Methods: A search of the literature was carried out in the PUBMED databases up to December 2017 using MeSH terms: ((("Arthritis, Rheumatoid" [Mesh] AND "Medication Adherence" [Mesh]) OR "Patient Compliance" [Mesh]) AND "Antirheumatic Agents" [Mesh]). Only articles that included an adult population and were in Spanish or English were reviewed. Results: From the 387 articles found, 43 were included for general review (definitions of adherence, compliance, concordance and persistence, components, classification and dimensions of adherence, risk factors related to non-adherence, description of direct and indirect methods for measuring adherence). Only 9 articles measured adherence and included information about risk factors related to non-adherence to oral treatment in rheumatoid arthritis. Conclusions: The adherence to pharmacological treatment in rheumatoid arthritis is sub-optimal and is associated with less effectiveness in the control of inflammatory activity. The main factors related to low adherence include problems of drug access and availability, increased activity and duration of the disease, polypharmacy, use of medications for prolonged periods, socioeconomic stratum, ethnicity, adverse drug reactions, perception of ineffectiveness of the medication, and concomitant diseases. It is necessary to incorporate the systematic measurement of pharmacological adherence within clinical practice. It is also important to identify the most frequent risk factors associated with low adherence, in order to design strategies aimed at improving patient adherence and achieve better clinical outcomes.


Subject(s)
Arthritis, Rheumatoid , Autoimmune Diseases , Treatment Adherence and Compliance , Effectiveness , Drug-Related Side Effects and Adverse Reactions
9.
Iatreia ; 31(4): 412-418, oct.-dic. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-975492

ABSTRACT

RESUMEN Ante la alta resistencia a los antibióticos por infecciones bacterianas multirresistentes a nivel intrahospitalario, se debe pensar en alternativas terapéuticas que requieren el uso de antibióticos potentes y dosis mayores. Presentamos el caso de un paciente de 56 años con múltiples intervenciones quirúrgicas quien había recibido manejo antibiótico previo. Al presentar deterioro clínico se aísla en hemocultivos Pseudomonas aeruginosa resistente a carbapenémicos, se inicia manejo con colistina intravenosa y doripenem, con el posterior desarrollo de una falla renal que se revierte al disminuir la dosis de colistina. Finalmente el paciente culmina el tratamiento con un ajuste de antibiótico de 10 días, con la respuesta clínica favorable.


SUMMARY Given the high resistance to antibiotics due to multiresistant bacterial infections at the hospital level, therapeutic alternatives that require the use of more potent antibiotics and higher doses should be considered. We presented the case of a 56-year-old patient with multiple surgeries and several previous antibiotic treatments. After clinical deterioration, a blood culture yield Pseudomonas aeruginosa resistant to carbapenems, treated with intravenous colistin and doripenem. The patient then developed acute renal failure, which reverts when the colistin dose decreases. Finally, the patient finishes the treatment with 10-day antibiotic adjustment and favorable clinical response.


Subject(s)
Humans , Colistin , Dosage
10.
J Med Case Rep ; 12(1): 62, 2018 Mar 09.
Article in English | MEDLINE | ID: mdl-29519244

ABSTRACT

BACKGROUND: Brucellosis is one of the most widespread zoonoses worldwide. It can affect any organ system, particularly the gastrointestinal system, but there is no report of acute liver failure as a brucellosis complication. CASE PRESENTATION: We present a case of acute liver failure secondary to brucellosis infection. A 75-year-old Hispanic man presented to a University Hospital in Chía, Colombia, with a complaint of 15 days of fatigue, weakness, decreased appetite, epigastric abdominal pain, jaundice, and 10 kg weight loss. On examination in an emergency room, abdomen palpation was normal with hepatosplenomegaly and the results of a liver function test were elevated. The diagnosis of brucellosis was confirmed by epidemiological contact and positive Rose Bengal agglutination with negative enzyme-linked immunosorbent assay immunoglobulin M for Brucella. He was then treated with doxycycline plus trimethoprim/sulfamethoxazole, with a favorable clinical outcome. CONCLUSIONS: The clinical presentation of brucellosis can be very imprecise because it can affect any organ system; however, there is no report of acute liver failure as a brucellosis complication. This is the first reported case in the Colombian literature of acute liver failure due to brucellosis. We found this case to be of interest because it could be taken into account for diagnosis in future appearances and we described adequate treatment and actions to be taken at presentation.


Subject(s)
Brucella melitensis/pathogenicity , Brucellosis/microbiology , Liver Failure, Acute/microbiology , Liver Function Tests , Occupational Diseases/microbiology , Aged , Animal Husbandry , Anti-Bacterial Agents/therapeutic use , Brucella melitensis/isolation & purification , Brucellosis/drug therapy , Brucellosis/physiopathology , Colombia , Doxycycline/therapeutic use , Enzyme-Linked Immunosorbent Assay , Humans , Liver Failure, Acute/drug therapy , Liver Failure, Acute/physiopathology , Male , Rose Bengal/analogs & derivatives , Treatment Outcome , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
11.
Infectio ; 17(3): 160-162, jul.-set. 2013. ilus, tab
Article in Spanish | LILACS, COLNAL | ID: lil-702962

ABSTRACT

El Streptococcus equi es un coco gram positivo, perteneciente al grupo C de Lancefield, causa una enfermedad de gran relevancia en caballos, la gurma o adenitis equina (1-2); en humanos, estas infecciones son poco frecuentes, siendo más frecuentes las infecciones de piel y tejidos blandos, faringitis, neumonía, síndrome tóxico similar al shock y endocarditis. Cuando la infección está asociada a bacteriemia, la mortalidad reportada es del 25%.(3) Presentamos el caso de un hombre de 44 años que ingresa al servicio de urgencias de la Clínica universidad de la Sabana con un cuadro clínico de celulitis en mano derecha por Streptococcus equi .


Streptococcus equi is a gram-positive cocci, from group C of Lance 􀃀 eld. It causes an important disease in horses, strangles or equine adenitis (1-2). In humans, these infections are rare, and skin and soft tissue infections, pharyngitis, pneumonia, toxic shock-like syndrome and endocarditis are more frequently observed. When the infection is associated with bacteremia, the reported mortality is near 25% (3). We report the case of a 44-year old man who was admitted to the emergency department of the University of Sabana Clinic with cellulitis due to Streptococcus equi in his right hand.


Subject(s)
Humans , Male , Adult , Gram-Positive Cocci , Streptococcus equi , Cellulite , Streptolysins , Viral Matrix Proteins , Risk Factors , Soft Tissue Infections , Virulence Factors
12.
Rev. salud bosque ; 3(1): 37-45, 2013.
Article in Spanish | LILACS | ID: lil-772961

ABSTRACT

El dolor es el principal motivo de consulta en el servicio de urgencias. Sin embargo, en múltiples estudios se confirma que los pacientes en los servicios de urgencias reciben un tratamiento sub óptimo. Por lo anterior, se deben adoptar estrategias para garantizar un adecuado estudio del dolor, analgesia apropiada, monitorización frecuente y nueva valoración del dolor con el objetivo de brindar analgesia adicional en caso de ser necesaria. La presente guía brinda grados de recomendación de los diferentes medicamentos utilizados en el manejo del dolor agudo en el servicio de urgencias con base en la información publicada hasta el momento. Se clasifica el dolor según las escalas internacionales validadas y se subdivide de acuerdo con el origen para orientar la elección del analgésico apropiado. Se hace un exhaustivo análisis de la utilidad de la dipirona en nuestro medio y se dan recomendaciones basadas en los datos disponibles para el uso seguro y costo-efectivo del tratamiento analgésico.


Pain is the chief complaint in the emergency department. Multiple studies confirm that patients in emergency departments receive suboptimal treatment. The following strategies should be adopted in order to ensure adequate assessment of pain, appropriate analgesia, frequent monitoring and reassessment of pain in order to provide additional analgesia if necessary. This guide provides recommended levels of different drugs used in the management of acute pain in the emergency department based on the evidence published so far. Pain is classified according to international validated scales and is divided according to the source to guide the choice of the appropriate analgesic. We performed a thorough analysis of the utility of dipyrone in our environment and give evidence-based recommendations for the safe and cost-effective analgesic therapy.


Subject(s)
Pharmacologic Actions , Analgesics, Opioid , Pain , Emergency Medicine
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