Using Prazosin to Treat Posttraumatic Stress Disorder and Associations: A Systematic Review.

OBJECTIVE: A central adrenergic hyperactivation is described in the neurobiology of posttraumatic stress disorder (PTSD) with probable variable symptomatic impact. Few studies have evaluated using the alpha-1 adrenergic antagonist prazosin for such symptoms; however, given the likely pathophysiology involved, this drug may play an important role in the pharmacological approach to PTSD. METHODS: This study assessed articles already published on the use of prazosin through a systematic review along a timeline in view of the symptomatic target of difficult access by standardized treatments. The impact of using this medication for the general symptoms of PTSD is also discussed. Several databases were searched for articles in the literature on the use of prazosin to treat PTSD. RESULTS: A total of 168 articles were found containing search terms in the title or abstract. Overall, 85 articles met the criteria described, and 48 studies were explored to conduct the present systematic review. Most articles showed some improvement after prazosin administration, especially in relation to sleep symptoms (nightmares and night waking). Only one article demonstrated no improvement after the use of this drug. More randomized studies are needed. CONCLUSION: Several clinical studies demonstrated the relevant role of prazosin for treating PTSD symptoms. Prazosin is an affordable and cost-effective pharmacological option compared to other drugs used to treat PTSD.

AMI and Anabolic-Androgenic Steroids: Case Report with Systematic Review.

INTRODUCTION: Coronary artery disease (CAD) represents approximately 390 thousand deaths per year in Brazil and is associated, among other predictors, with the use of anabolic and androgenic steroids (AAS). OBJECTIVE: To analyze a clinical case of a patient who suffered AMI after abuse of AAS. A systematic literature review has been carried out to physiologically analyze the main factors that can lead to AMI with the use of these hormones. METHODS: The EVR patient, 41 years old, denies any comorbidities or use of medications. He has been admitted to the emergency room due to typical angina-precordial pain in tightness associated with eventual back pain and paresthesia of both upper limbs, after intense physical effort at the gym, without improvement at rest, and with partial improvement after first care at the health unit. The patient was hypertensive in an emergency bed after the occurrence of ST elevation. The patient alleges the use of anabolic steroids for one month. The patient presented with obstructive atherosclerotic coronary artery disease with total occlusion of the anterior descending artery. Systematic review: A total of 89 clinical studies have been compared and submitted to eligibility analysis, with 50 studies selected, according to the PRISMA rules. RESULTS: Long-term consumption of AAS may cause pathological changes, however, AAS can increase protein synthesis, muscle growth, and erythropoiesis. CONCLUSION: Abuse of AAS has a toxic cardiovascular effect, which significantly increases the incidence of cardiovascular diseases.

Correction to: Endoscopic Argon Plasma Coagulation Vs. Multidisciplinary Evaluation in the Management of Weight Regain after Gastric Bypass Surgery: a Randomized Controlled Trial with SHAM Group.

In the original article the captions for Figs. 1-3 are incorrect.

Endoscopic Argon Plasma Coagulation vs. Multidisciplinary Evaluation in the Management of Weight Regain After Gastric Bypass Surgery: a Randomized Controlled Trial with SHAM Group.

BACKGROUND: Roux-en-Y gastric bypass is one of the most widely performed bariatric surgeries. However, the relapse of obesity occurs in approximately 20% of patients and enlargement of the anastomosis is one of the factors associated with this relapse. Endoscopic treatment of the anastomosis has been proposed to assist in renewed weight loss. One endoscopic technique is the narrowing of the anastomosis argon plasma coagulation (APC). OBJECTIVE: Evaluate the effectiveness and safety of the endoscopic treatment of an enlarged anastomosis with APC. METHODS: A randomized controlled study was conducted comparing APC to exclusive multidisciplinary management after weight regain. RESULTS: Forty-two patients were divided into two groups: APC (n = 22) and control (n = 20). After 14 months of follow-up with a crossover at 6 months, significant improvement in satiety and greater weight loss were found in the APC group and after crossover. APC was associated with significant weight loss [9.73 (7.46, 12) vs. + 1.38 (- 1.39, 2.15)], a reduction in the anastomosis diameter [p < 0.001], early satiation [0.77 (0.44, 1.11) vs. - 0.59 (- 0.95, - 0.23), p < 0.001], and increased quality of life measured using the EQ5D index [p = 0.04] and EQ5D VAS scale [p = 0.04]. Considering total mean weight loss throughout the entire follow-up, weight loss was similar in both groups (13.02 kg in the APC and 11.52 kg in the control). CONCLUSION: Treatment of the gastrojejunal anastomosis with APC was effective and safe, with significant weight loss, the return of early satiation, and an improvement in quality of life.

A Case of Adolescent Cronkhite-Canada Syndrome.

The Cronkhite-Canada syndrome (CCS) was first reported in 1955, since then more than 500 cases have been reported, indicating an estimated incidence of one case per 1 million inhabitants. The syndrome occurs predominantly in male, with a ratio of three males to two females. Because of the rarity of the syndrome, there are no evidence-based therapies and the treatments described include a combination of therapies, but none is consistently effective. Surgery is usually reserved for the treatment of complications. Herein, we present a case of adolescent CCS. The patient was a 15-year-old boy who presented with watery diarrhea with 20 episodes a day, vomiting and abdominal pain for 4 weeks, with a weight loss of 8.0 kg (15.0% of initial weight). Endoscopic examination revealed polyposis in the stomach, duodenum, and colon. CCS was diagnosed and the patient was treated with a combined corticosteroid and metronidazole. Followed up at 8 month after the diagnosis, the patient was asymptomatic.