ABSTRACT
Objetivos: demonstrar efeito cardiovascular provocado por inibidor da acetilcolinesterase (IAChE), potencializado pelo uso associado de beta bloqueador adrenérgico. Materiais e métodos: paciente M.R., 80 anos, sexo masculino, internado com quadro de rebaixamento do nível de consciência. Apresentava-se ictérico, hipotenso (PA: 80x50 mmHg) e bradicárdico (FC: 36bpm). Ausculta cardíaca com bulhas rítmicas, em 2 tempos, sem sopro. Pulmão e abdome sem alterações. Sem déficit focal e sem sinais meníngeos. Antecedentes de etilismo e tabagismo. Portador de hepatopatia crônica, hipotiroidismo, hipertensão arterial sistêmica, insuficiência renal crônica e síndrome demencial tipo Alzheimer. Fazia uso de Inibidor de ECA, Levotiroxina, Ácido fólico, Omeprazol, Diuréticos, Tiamina, Beta bloqueador e um, IAChE, ECG: bradicardia sinusal, FC: 36 bpm, Hemograma: discreta anemia macrocítica; leucograma sem alterações e plaquetopenia: 72000, Creatinina: 2,4mg/dl, Uréia: 125 mg/dl, Sódio: 134mmol/L, Potássio: 5,3 mmol/L . Glicemia: 97 mg/dl, Enzimas cardíacas normais. TGO: 97 U/L, TGP: 75 U/L, DHL: 249 U/L, Bilirrubina total: 1,45 mg/dl, Bilirrubina direta: 0,61 mg/dl , Bilirrubina indireta: 0,84 mg/dl, TAP: 16,1 seg, AP: 67%, INR:1,34, Proteínas totais: 5,9 g/dl, Albumina 2,3 g/dl, TSH: 3,4 mUl/ml. O beta bloqueador foi suspenso no dia da internação, porém o paciente manteve-se bradicárdico. Dois dias após, o IAChE foi suspenso. Conclusão: a freqüência de efeitos cardiovasculares associados aos IAChEs são: vertigem e síncope (1 a 10%), bradicardia, arritmias atriais, infarto do miocárdio, angina, convulsões (0,01 a 1%), bloqueio não atrial e atrioventricular (0,001 a 0,1%). Revisões revelam que a incidência de efeitos colaterais cardiovasculares são raros com o uso dos IAChEs (AU)
Subject(s)
Cholinesterase Inhibitors/administration & dosage , Heart , AgedABSTRACT
Objetivos: demonstrar efeito cardiovascular provocado por inibidor da acetilcolinesterase (IAChE), potencializado pelo uso associado de beta bloqueador adrenérgico. Materiais e métodos: paciente M.R., 80 anos, sexo masculino, internado com quadro de rebaixamento do nível de consciência. Apresentava-se ictérico, hipotenso (PA: 80x50 mmHg) e bradicárdico (FC: 36bpm). Ausculta cardíaca com bulhas rítmicas, em 2 tempos, sem sopro. Pulmão e abdome sem alterações. Sem déficit focal e sem sinais meníngeos. Antecedentes de etilismo e tabagismo. Portador de hepatopatia crônica, hipotiroidismo, hipertensão arterial sistêmica, insuficiência renal crônica e síndrome demencial tipo Alzheimer. Fazia uso de Inibidor de ECA, Levotiroxina, Ácido fólico, Omeprazol, Diuréticos, Tiamina, Beta bloqueador e um, IAChE, ECG: bradicardia sinusal, FC: 36 bpm, Hemograma: discreta anemia macrocítica; leucograma sem alterações e plaquetopenia: 72000, Creatinina: 2,4mg/dl, Uréia: 125 mg/dl, Sódio: 134mmol/L, Potássio: 5,3 mmol/L . Glicemia: 97 mg/dl, Enzimas cardíacas normais. TGO: 97 U/L, TGP: 75 U/L, DHL: 249 U/L, Bilirrubina total: 1,45 mg/dl, Bilirrubina direta: 0,61 mg/dl , Bilirrubina indireta: 0,84 mg/dl, TAP: 16,1 seg, AP: 67%, INR:1,34, Proteínas totais: 5,9 g/dl, Albumina 2,3 g/dl, TSH: 3,4 mUl/ml. O beta bloqueador foi suspenso no dia da internação, porém o paciente manteve-se bradicárdico. Dois dias após, o IAChE foi suspenso. Conclusão: a freqüência de efeitos cardiovasculares associados aos IAChEs são: vertigem e síncope (1 a 10%), bradicardia, arritmias atriais, infarto do miocárdio, angina, convulsões (0,01 a 1%), bloqueio não atrial e atrioventricular (0,001 a 0,1%). Revisões revelam que a incidência de efeitos colaterais cardiovasculares são raros com o uso dos IAChEs
Subject(s)
Aged , Cholinesterase Inhibitors/administration & dosage , HeartABSTRACT
Several studies have been conducted in order to verify effects of laser irradiation on dental structures. However, different settings and methods employed have led to inconclusive results. The aim of this study was to evaluate the effects of several settings of Nd:YAG laser irradiation on enamel microhardness. Fifteen groups of 10 human third molars each were submitted to Vickers microhardness indentations prior to and after laser irradiation. The data were submitted to the t-test for dependent samples (P < 0.05) for statistical evaluation. Lower total delivered energy (under 30 J) resulted in no statistically significant difference of microhardness between irradiated and non-irradiated samples, whereas higher energy settings decreased enamel surface microhardness significantly. This can be due to the significant temperature rise during irradiation. Thus, we conclude that laser irradiation, under the conditions of this study, is not suitable for improving enamel properties, because of decreased microhardness of irradiated samples.
Subject(s)
Dental Enamel/radiation effects , Lasers , Aluminum Silicates , Dental Enamel/ultrastructure , Hardness , Humans , Neodymium , Radiation Dosage , Statistics as Topic , Stress, Mechanical , Temperature , YttriumABSTRACT
In order to obtain specialist training in Portugal, doctors must pass a multiple-choice examination. The aim of this article is to present a structural and mathematical analysis of the examinations in the last three years. We based our work on the calculation of reliability coefficient of the examinations, and the difficulty and discrimination index of the questions and the examinations as a whole. A detailed analysis of the examinations, including that of each of the three hundred questions, will be published by the Department of Health Manpower in January, 1997.
Subject(s)
Education, Medical , Educational Measurement/statistics & numerical data , Internship and Residency/statistics & numerical data , Specialization , Humans , Medicine/statistics & numerical data , Portugal , Reproducibility of ResultsSubject(s)
Chromosome Aberrations , Chromosome Disorders , X Chromosome , Adult , DNA/genetics , Female , Humans , Male , Polymorphism, Restriction Fragment LengthABSTRACT
The objectives of this open, prospective, randomized and comparative study were to evaluate and compare the efficacy and safety of intravenous ceftriaxone (active ingredient of Rocephin) and cefotaxime in treatment of bacterial pneumoniae. Forty-three patients were enrolled in the study and in 40 (21 in the ceftriaxone group and 19 in the cefotaxime group) we were able to make an evaluation. Bacteriological results were essentially based on a positive culture obtained with transtracheal aspirate (TTA) - 34 out of 40 cases; in the remaining patients, at least an initial positive sputum culture was obtained. Most of the lower respiratory tract infections were secondary to previous chronic respiratory diseases or were nosocomial infections; 25 out of 40 cases were considered to be severe or critical situations. The overall efficacy (bacteriological eradication plus clinical cure or clear improvement) of ceftriaxone and cefotaxime were 90.5% (19/21) and 73.7% (14/19), respectively (p less than 0.05). The tolerability of both drugs was good: 16 (76.2%) patients in the ceftriaxone group and 12 (63.2%) in the cefotaxime group had no adverse events, while in 5 and 7 patients, respectively, tolerability was considered satisfactory (minor side effects, none of which required discontinuation or even reduction of dosage).
Subject(s)
Bacterial Infections/drug therapy , Cefotaxime/therapeutic use , Ceftriaxone/therapeutic use , Respiratory Tract Infections/drug therapy , Adult , Aged , Bacterial Infections/epidemiology , Female , Humans , Male , Middle Aged , Prospective Studies , Random Allocation , Respiratory Tract Infections/epidemiologySubject(s)
Misonidazole/administration & dosage , Neoplasms/drug therapy , Nitroimidazoles/administration & dosage , Administration, Oral , Drug Administration Schedule , Drug Evaluation , Humans , Misonidazole/adverse effects , Misonidazole/metabolism , Nausea/chemically induced , Neoplasms/radiotherapy , Peripheral Nervous System Diseases/chemically induced , Sensation/drug effects , Vomiting/chemically inducedABSTRACT
We measured procainamide (I) and its metabolite, N-acetylprocainamide (II), in human serum samples by solvent extraction, high-performance liquid chromatography on a reverse phase column, and detection at 280 nm, with use of external standards. The method requires 0.2 ml of serum and is sensitive to 0.3 mg of I and 0.6 mg of II per liter of serum, with intra-assay standard deviations of 0.22 and 0.24 mg/liter, respectively, at 5 mg/liter (N=10) and inter-assay standard deviations of 0.63 and 0.81 mg/liter, respectively, at 7.5 mg/liter (CV 8.4 and 10.5%, respectively, n = 20). Concentrations measured by high-performance liquid chromatography and by an established fluorescence technique correlated well (r = 0.98 for I and 0.97 for II). No interfering substances were found in 20 randomly selected sera from patients receiving a large number of other drugs. Of the pure drug substances tested only sulfathiazole interfered with the assay of II. The method is therefore suitable for routinely monitoring these compounds in serum in a clinical laboratory. The high concentrations of the metabolite in a significant number of patients demonstrate the need to consider it as well as the parent drug as guides in optimizing dosage regiments for I.
