ABSTRACT
El uso de corticoides en el tratamiento del dolor ha sido una práctica habitual desde mediados del siglo pasado. A raíz de una revisión de las complicaciones acontecidas con su administración por vía epidural, la Administración de Alimentos y Medicamentos de Estados Unidos (FDA) emitió una «controvertida alerta» solicitando se añada una «advertencia» en el etiquetado de los corticoides inyectables donde se deben describir dichos riesgos (pérdida de la visión, derrame cerebral, parálisis y muerte) al ser suministrados por esta vía. Es importante resaltar la existencia de diferentes clases de corticoides con características diversas que hace, que los potenciales efectos secundarios de su uso también sean distintos. Creemos necesario, en vista de los acontecimientos mencionados, las controversias que se han generado y la falta de estudios bien realizados sobre el uso de los corticoides, tanto en infiltraciones epidurales y como en otros procedimientos, comenzar por realizar una revisión general sobre sus indicaciones, efectos secundarios, complicaciones y características particulares de los diferentes compuestos en diversas enfermedades dolorosas (AU9
Corticosteroids been used frequently in pain treatments since the middle of last century (1952). Due to a review of the complications as a result of their application in epidural injections, the United States of America Food and Drug Administration (FDA) issued an «alert controversy» requesting that a warning label should be added to injectable corticosteroids, where risks must be described (loss of sight, brain damage, paralysis and death) when administering by this route. It must be mentioned that there are different types of corticosteroids with diverse characteristics, which as a result, may produce different side-effects. Due to the aforementioned developments, the controversies that have arisen, and the lack of well-conducted studies on the use of steroids in epidural injections, we must begin by reviewing their indications in different pain conditions (AU)
Subject(s)
Humans , Male , Female , Chronic Pain/drug therapy , Adrenal Cortex Hormones/classification , Adrenal Cortex Hormones/therapeutic use , Dexamethasone/therapeutic use , Triamcinolone/therapeutic use , Betamethasone/therapeutic use , Anesthesia, Epidural , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Adrenal Cortex Hormones/pharmacology , Anesthesia, Epidural/instrumentation , Anesthesia, Epidural/methods , Drug-Related Side Effects and Adverse Reactions/epidemiology , Drug-Related Side Effects and Adverse Reactions/prevention & control , Hypoglycemia/complications , Hyperglycemia/complications , Osteoporosis/complicationsABSTRACT
Corticosteroids been used frequently in pain treatments since the middle of last century (1952). Due to a review of the complications as a result of their application in epidural injections, the United States of America Food and Drug Administration (FDA) issued an «alert controversy¼ requesting that a warning label should be added to injectable corticosteroids, where risks must be described (loss of sight, brain damage, paralysis and death) when administering by this route. It must be mentioned that there are different types of corticosteroids with diverse characteristics, which as a result, may produce different side-effects. Due to the aforementioned developments, the controversies that have arisen, and the lack of well-conducted studies on the use of steroids in epidural injections, we must begin by reviewing their indications in different pain conditions.
Subject(s)
Chronic Pain/drug therapy , Adrenal Cortex Hormones , Glucocorticoids , Humans , Injections, Epidural , United States , United States Food and Drug AdministrationABSTRACT
AIDS threatens to spread rapidly in Mexico. In the present study, results of a survey of 204 Mexican employees in hospitals and doctors' offices indicated that those health-care workers were largely knowledgeable about the illness. A majority were willing to provide AIDS care, although they feared contagion. Multiple regression analyses indicated that (a) attitudes toward high-risk groups (intravenous drug users and homosexuals) and (b) fear of contagion were both related to intentions to provide care to AIDS patients.
PIP: A survey conducted in Ciudad Juarez, in the Mexican state of Chihuahua, investigated health care workers' (HCWs) AIDS knowledge, attitudes, and willingness to provide care to AIDS patients. Questioned were 171 HCWs employed in a public charity hospital and 33 from private physicians' offices. 24% of respondents were nurses and 22% were doctors; mean age was 28 years. On average, respondents answered 82% of the AIDS-related knowledge items correctly and 76% felt their education had prepared them to treat AIDS patients. Despite widespread awareness of the modes of HIV transmission and the universal precautions, 87% expressed concern about becoming infected with HIV through patient care. 81% indicated they were willing to treat AIDS patients. Most HCWs had positive (19%) or neutral (53%) attitudes toward homosexuals, but 44% expressed negative attitudes toward intravenous drug users. Multiple regression analysis found that attitude toward high-risk groups and fear of contagion, but not knowledge, were related to behavioral intention to provide AIDS care. This finding is consistent with research indicating that knowledge-based programs that fail to address the affective component of AIDS care are insufficient for changing AIDS care intentions and behaviors. Overall, AIDS patients in the border areas of Mexico, appear to be receiving more effective treatment than those in parts of the country with lower AIDS prevalence. Reports from the latter areas allege incidents of refusal to provide medical care to AIDS patients or the provision of substandard care.
