ABSTRACT
La estricnina se emplea como rodenticida y suele ser causa de intoxicación accidental. Debido a su sabor amargo y su efecto anestésico local, se utiliza para adulterar drogas ilícitas como la cocaína y la heroína. Se presenta el caso de un joven adicto a la cocaína que ingresa con rigidez de los músculos de la cara, trismo, extensión y lateralización hacia la izquierda de la cabeza, fasciculaciones de los músculos de la cara y un episodio mayor con hiperextensión del cuerpo en pleno estado de lucidez. Se plantearon como diagnósticos diferenciales: abuso de drogas, encefalitis, rabia, epilepsia y tétanos. Los estudios de rutina fueron normales, el electroencefalograma demostró una patente epileptógena focal y el examen de orina confirmó la presencia de cocaína y estricnina. El tratamiento de la intoxicación con estricnina debe dirigirse a evitar las convulsiones y apoyar la función respiratoria; se debe tratar con diazepam y eventualmente anestésicos y bloqueadores neuromusculares. La evolución puede ser fatal por parálisis bulbar, rabdomiólisis, mioglobinuria y acidosis láctica. En pacientes con antecedentes de consumo de cocaína, la presencia de un cuadro similar al tétanos debería hacer pensar en intoxicación con estricnina ya que el diagnóstico y tratamiento temprano mejoran la supervivencia (AU)
Subject(s)
Adult , Male , Humans , Strychnine/toxicity , Cocaine/administration & dosage , Cocaine/toxicity , Diazepam/administration & dosage , Diazepam/therapeutic use , Poisoning , Poisoning/complications , Poisoning/drug therapy , Substance-Related Disorders/diagnosis , Substance-Related Disorders/therapy , Substance-Related Disorders/complications , Substance-Related Disorders/diagnosis , Trismus/complications , Trismus/diagnosis , Fasciculation/complications , Fasciculation/diagnosis , Diagnosis, Differential , Encephalitis/complications , Encephalitis/diagnosis , Rabies/diagnosis , Epilepsy/diagnosis , Rodenticides/administration & dosage , Rodenticides/toxicity , Rhabdomyolysis/complications , Rhabdomyolysis/diagnosis , Myoglobinuria/complications , Myoglobinuria/diagnosis , Acidosis, Lactic/complications , Acidosis, Lactic/diagnosis , Tetanus/diagnosis , Bulbar Palsy, Progressive/complications , Bulbar Palsy, Progressive/diagnosisABSTRACT
El mayor riesgo de infección asociado a un dispositivo intrauterino (DIU) se observa en jóvenes, nulíparas, con múltiples parejas sexuales y durante los primeros meses después de su colocación. Los gérmenes causales son los propios de la flora vaginal. El comienzo de la enfermedad pelviana inflamatoria (EPI) asociada al DIU suele ser gradual con cervicitis inicial, endometritis, salpingitis y finalmente peritonitis. Si bien el uso prolongado del DIU no aumenta el riesgo de EPI, en determinadas pacientes favorece el desarrollo de endometritis crónica anaeróbica (ECA), por lo general asintomática. En este trabajo se presenta un caso de EPI por un microorganismo no habitual, Acinetobacter baumanii, en una paciente de 52 años cuyo único factor predisponente fue el uso de un DIU durante 16 años (AU)
Subject(s)
Female , Middle Aged , Humans , Acinetobacter/pathogenicity , Acinetobacter Infections/diagnosis , Intrauterine Devices/adverse effects , Pelvic Inflammatory Disease/etiology , Acinetobacter/isolation & purification , Acinetobacter Infections/drug therapy , Intrauterine Devices/microbiology , Endometriosis/etiology , Salpingitis/etiology , Peritonitis/etiology , Ceftriaxone/therapeutic use , Clindamycin/therapeutic use , Critical Care , Laparotomy , Pelvic Inflammatory Disease/diagnosis , Pelvic Inflammatory Disease/drug therapy , Uterine Cervicitis/etiologyABSTRACT
OBJECTIVE: To test the psychometric properties of the Italian version of the WHOQOL-BRIEF (e.g., construct and internal validity, concurrent validity with the MOS SF-36 and test-retest reliability). The WHOQOL-BRIEF is a 26-items self-report instrument which assesses four domains assumed to represent the Quality Of Life (QOL) construct: physical domain, psychological domain, social relationships domain and environment domain, plus two facets for assessing overall QOL and general health. METHODS: Data have been collected in three sites (Bologna, Modena and Padua), located in the North of Italy, in the framework of the international WHOQOL project. According to the study design, the sample had to include about 50% males and 50% females, 50% of subjects below and 50% above the age of 45, all in contact with various health services. A subsample has been re-interviewed after 2-3 weeks in order to study test-retest reliability. After the WHOQOL-BRIEF, most subjects have also been administered the MOS-SF36 in order to test the concurrent validity between these two instruments. RESULTS: The instrument was administered to 379 subjects (1/6 healthy and 1/6 sick), chosen to be representative of a variety of different medical conditions. Seventy patients, who displayed stable health conditions, have been reassessed after 2-3 weeks to study test-retest reliability. The WHOQOL-BRIEF domains has shown good internal consistency, ranging from 0.65 for the social relationships domain to 0.80 for the physical domain; it has been able to discriminate between in- and out-patients and between the two age groups considered in the present study (< 45, > or = 45 years). Only physical and psychological domains were found to discriminate between healthy and ill subjects. No gender differences in the mean scores for the four domains were found. Concurrent validity between the WHOQOL-Brief and the MOS-SF-36 was satisfactory, and specific for the physical and psychological health domains. Test-retest reliability values were also good, ranging from 0.76 for the environment domain to 0.93 for the psychological domain. CONCLUSIONS: This study shows that the WHOQOL-BRIEF is psychometrically valid and reliable, and that it is also potentially useful in discriminating between subjects with different health conditions in clinical settings.
