Ultra-rapid opiate detoxification using deep sedation and prior oral buprenorphine preparation: long-term results.

BACKGROUND: New methods of ultra-rapid opiate detoxification (URD) under intravenous sedation have been criticized because of limited data on safety and long-term follow-up. Premedication with buprenorphine has been advocated to improve safety by decreasing vomiting. Prior research has not explored URD in socially impaired patients. METHOD: Sixteen patients were detoxified with URD and prospectively evaluated over at least 30 months. Data of this procedure were compared with those of our previous study without buprenorphine preparation (Drug Alcohol Depend. 52(3) (1998) 243). The 16 patients were followed up by a general practitioner (GP) before and after URD. The GPs also supervised the 7-day course of buprenorphine treatment prescribed for the 16 patients prior to URD. RESULTS: During the procedure, only one episode of vomiting occurred instead of 13 out of 20 in our previous study. Post-procedure, only two patients experienced moderate withdrawal symptoms, such as persistent nausea, abdominal cramps and vomiting lasting from 24 to 48 h, in comparison with most patients in the previous study without buprenorphine. After a period of at least 30 months (36.0+/-6.38), the 16 patients were still alive and were regularly monitored by their GP. Only two of the 16 never relapsed after URD and reported total opiate abstinence. Fourteen patients relapsed; 12 of these were prescribed a licensed methadone substitution program and two were still using heroin. CONCLUSION: In this small sample, the data indicated that URD with buprenorphine preparation was safe and that it markedly decreased post-procedure morbidity. No patient died over a minimum 30-month follow-up period. Furthermore, the procedure was employed with socially impaired patients. In the long term, a few patients were still free of opiates, while the majority opted for a methadone maintenance program, showing that URD can serve as one possible step in a long-term treatment program.

Spontaneous poisoning by Ricinus communis (Euphorbiaceae) in cattle

The aim of this study is to report cases of spontaneous poisoning of cattle by Ricinus communis (castor beans) in Paraíba, a semiarid region of northeastern Brazil. The cases were observed in 2 herds on neighboring properties in 2013. Clinical signs developed within 6-24 h and consisted of weakness, tachycardia, dyspnea, profuse watery diarrhea, dehydration, depression, instability, cramps, permanent lateral recumbency and death within 48-72 h. Of the 60 cattle at risk, 19 were affected and 14 died. Five fully recovered after the course of 12 days. Three animals were necropsied. The main gross lesions were hemopericardium, hemothorax, pulmonary edema, petechial hemorrhages in the epicardium and endocardium, ecchymoses at the papillary muscles and suffusions on the intercostal muscles. Hemorrhages were also observed in the abdominal cavity, spleen and mucosa of the abomasum and small intestine. The rumen content was liquid with a large amount of castor bean seeds. There were circular, whitish and focally diffuse areas in the liver parenchyma. The main microscopic lesions consisted of multifocal coagulative myocardial necrosis with the presence of mononuclear cell infiltration and varying degrees of bleeding between cardiac muscle fibers. The abomasum and small intestine mucosae and submucosa had mild edema and mononuclear and polymorphonuclear inflammatory cell infiltration. The diagnosis of R. communis was based on the history of plant consumption, clinical signs, pathology of the disease and the presence of large amounts of castor bean seeds in the forestomachs.

Sleep habits and complaints of adults in the city of São Paulo, Brazil, in 1987 and 1995

This study compares the prevalence of complaints of insomnia, excessive diurnal sleepiness, parasomnias, and sleep habits of the adult population in the city of São Paulo, Brazil, estimated in surveys carried out in 1987 and 1995. Representative samples of 1000 adult residents per survey were interviewed using a validated structured sleep questionnaire, the "UNIFESP Sleep Questionnaire". Difficulty maintaining sleep, difficulty initiating sleep and early morning awakening, occurring at least three times a week, were reported in 1987 and 1995, by 15.8/27.6, 13.9/19.1, and 10.6/14.2% of the interviewees, respectively, significantly increasing throughout time. These sleep problems were more often found among women. Frequencies of excessive diurnal sleepiness and sleep attacks were unchanged comparing 1987 with 1995 (4.5 vs 3.8 and 3.1 vs 3.0%, respectively). Parasomnia complaints remained unchanged, with the exception of leg cramps, which doubled in prevalence from 1987 to 1995 (2.6 to 5.8%). Snoring was the most common parasomnia (21.5% in 1995), reported more often by men than by women, and somnambulism was the least common (approximately 1%). Besides sleeping slightly less, interviewees went to bed and woke up later in 1995. Approximately 12% of the subjects in both surveys had consulted a physician due to sleep problems and 3.0% reported habitual use of sleep-promoting substances in 1995. Overall, there was a significant increase in insomnia complaints from 1987 to 1995 in the general population of the city of São Paulo. This major change over a little under a decade should be considered as an important public health issue.

Analysis of tapping test results in a test battery for advanced PD patients

Objective: To compare results from various tapping tests with diary responses in advanced PD. Background: A home environment test battery for assessing patient state in advanced PD, consisting of diary assessments and motor tests was constructed for a hand computer with touch screen and mobile communication. The diary questions: 1. walking, 2. time in off , on and dyskinetic states, 3. off at worst, 4. dyskinetic at worst, 5. cramps, and 6. satisfied with function, relate to the recent past. Question 7, self-assessment, allows seven steps from -3 ( very off ) to +3 ( very dyskinetic ) and relate to right now. Tapping tests outline: 8. Alternately tapping two fields (un-cued) with right hand 9. Same as 8 but using left hand 10. Tapping an active field (out of two) following a system-generated rhythm (increasing speed) with the dominant hand 11. Tapping an active field (out of four) that randomly changes location when tapped using the dominant hand Methods: 65 patients (currently on Duodopa, or candidates for this treatment) entered diary responses and performed tapping tests four times per day during one to six periods of seven days length. In total there were 224 test periods and 6039 test occasions. Speed for tapping test 10 was discardedand tests 8 and 9 were combined by taking means. Descriptive statistics were used to present the variation of the test variables in relation to self assessment (question 7). Pearson correlation coefficients between speed and accuracy (percent correct) in tapping tests and diary responses were calculated. Results: Mean compliance (percentage completed test occasions per test period) was 83% and the median was 93%. There were large differences in both mean tapping speed and accuracy between the different self-assessed states. Correlations between diary responses and tapping results were small (-0.2 to 0.3, negative values for off-time and dyskinetic-time that had opposite scale directions). Correlations between tapping results were all positive (0.1 to 0.6). Conclusions: The diary responses and tapping results provided different information. The low correlations can partly be explained by the fact that questions related to the past and by random variability, which could be reduced by taking means over test periods. Both tapping speed and accuracy reflect the motor function of the patient to a large extent.

Increasing trends of sleep complaints in the city of São Paulo, Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Adventure race's injuries

Objective. - To describe the distribution of frequency of the injuries during adventure competition.Material and methods. - Fifty-five participants who underwent to the second stage of the Caloi Adventure Camp competition answered to a questionnaire about their personal characteristics, training status and injuries.Results. - The age of the athletes was 32 +/- 10 years old and the body mass index (BMI) 23.3 +/- 2.2 kg/m(2). The most frequent injuries occurred during trekking (61%), followed by mountain bike (24%). Abrasions (36.7%) and cuts (24.5%) were the most frequent injuries mentioned. Tissue level lesions occurred in 61.2% of the episodes. The most frequent injuries were contusions (16.3%) at muscular level, and sprain (6.1%) and fracture (6.1%) at osteoarticular system. Related to the body structure, the lower limb was the most affected (49%), mainly ankle (14.3%) and knee (12.2%). In the upper limb (30.6%), arm and forearm were more affected with cuts and abrasions. Neck and trunk were responsible for 20.4% of the injuries. Cramps (31%) and tendinitis (11%) were also mentioned.Conclusion. - The data suggest that it is necessary to create one training approach including prevention and logistics for participants rescue and rapid attendance during the tournament. (C) 2008 Published by Elsevier Masson SAS.

Agricultura familiar: uma perspectiva da qualidade de vida do produtor rural orgânico da Paraíba

Knowledge of quality of life is a very complex and rich in cultural and subjective dimensions, understood in a broad sense and multivariate theme. Considering the rural areas from agriculture, it is observed that the production standard defines significant changes in the environmental context and the quality of life of rural workers. To explain the relationship between quality of life and Family Organic Agriculture, we sought to analyze the quality of life of the organic family farmer, after change in agricultural management. The research, based on a procedure exploratory study supported the articulation theoretically constructed, showed their relevance and allowed to delimit with greater security, the central question of work. The WHOQOL - 100 treated the instrument of research on quality of life that directed the field study with organic farmers from the town of Lagoa Seca / PB. Farmers and family members are from rural regions Almeida, Alvinho, Lagoa de Barro, Lagoa Gravatá, Oiti and Pau Ferro. The average time is 39 years farming and organic family farm is 16 years. In the analysis work was found that the process of production of vegetables and fruits is divided into 08 steps and with respect to workloads observations showed the presence of: physical loads, mechanical stresses, psychological burden and ergonomic factors. Most farmers reported symptoms were fatigue and cramps in the legs . Regarding the quality of life was noticed that the Psychological Domain contributed positively to the quality of life with mean and standard deviation (17.83 ± 12.78) and Domain Environment negatively contributing to the quality of life of this group (9.00 ± 6.82). We conclude that the practice of Family Organic Agriculture should be seen as an effective strategy in promoting quality of life and social values in between, since it presents environmental sustainability with regard to life and socio-cultural diversity of populations

Doença de Chagas aguda pós-transfusional sem miocardite

Trata-se de paciente do sexo feminino, com 59 anos de idade, procedente de Itaporanga (SP), diabética e nefropata crônica, internada em virtude de surtos de pielonefnte e insuficiência renal aguda. Dentre outras medidas terapêuticas, recebeu transfusão de sangue. Cerca de dois dias após a última transfusão (sangue oriundo de doador, posteriormente identificado como chagásico) encontraram-se formas tripomastigotas de Trypanosoma cruzi em lâmina preparada para execução de hemograma. Iniciou-se tratamento com Benzonidazol. A paciente cursou para, pleuropneumonia e de secreção purulenta cirúrgica isolou-se Klebsiella spp. A septicemia conduziu a paciente ao êxito letal. Nenhuma lesão tecidual foi observada no miocárdio, no sistema nervoso central, adrenal ou nos demais órgãos examinados.

Efeitos da redução da concentração de sódio de diálise sobre o volume de água corporal e marcadores inflamatórios em pacientes com insuficiência renal crônica em tratamento hemodialítico

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação das atividades mutagênica, pró-inflamatória e estrogênica de Machaerium hirtum e Crotalaria pallida

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Investigação fitoquímica biomonitorada da tintura 70% de Arrabidaea chica (Humb. & Bompl.) Verlot

A Arrabidaea chica (H&B) Verlot, popularmente conhecida como pariri ou crajirú. É um arbusto escandente de pequeno porte, aproximadamente 2,5 m de altura, que ocorre do sul do México até o Brasil central, sendo comum na Amazônia, onde é utilizada pelos índios para a pintura corporal. Popularmente o chá das folhas é indicado para inflamação, anemia, cólicas intestinais, regulação de menstruação, diarréia entre outros. Estudos recentes comprovam sua atividade antioxidante e cicatrizante in vivo e in vitro, além de atividade antifúngica contra Trichophyton mentagrophytes e do efeito tripanocida. O presente trabalho tem por objetivo contribuir para a validação da alegação de uso e para a padronização de forma de emprego da A. chica enquanto recurso fitoterápico, uma vez que a mesma encontrase na RENISUS. Os extratos etanólico e aquoso da planta foram investigados quanto a seus metabolitos secundários. Foram determinados parâmetros para o controle de qualidade da droga vegetal, através de granulometria, perda pó dessecação e cinzas totais. Além da obtenção de perfis cromatográficos por CCD, CLV, LC-MS e LC - DAD. A planta encontra-se com seus parâmetros de controle de qualidade em conformidade com a literatura. Um perfil de CCD obtido com o eluente Hexano/Acetona/MeOH (67,5:27,5:5) e revelado com NP/PEG, revelou uma banda com Rf=0,17 com fluorescência amarela característico de flavonóides. No perfil de CLAE - DAD obteve-se cromatogramas com características de quinonas e flavonóides também. A partir destes resultados o trabalho foi direcionado para o isolamento, inicialmente com o fracionamento da FAE por CLV e a analise das frações resultantes por CLAE-DAD, e como resultado foi sugerido a presença de um flavonóide derivado do flavonol apigenina. Os resultados microbiológicos corroboram com alguns de seus usos populares contribuindo assim para a validação da forma de uso alegada da planta.

Plantas medicinais abortivas utilizadas por mulheres de UBS: etnofarmacologia e análises cromatográficas por CCD e CLAE

The use of medicinal plants corresponds to an ancient practice, either as an alternative medicine for the cure of several diseases, or as a method of abortion. Nevertheless, the population in general does not know the risks involved in the use of medicinal plants. In this sense, the purpose of the study was to evaluate the consumption rate of medicinal plants by women in a Basic Health Unit (BHU), on order to identify which plant species have been most frequently consumed by them, including during the pregnancy. Through an exploratory questionnaire with 48 women, it was observed that most part of the interviewees had children and the most of them cited Peumus boldus, Baccharis trimera and Cassia angustifolia, which were mainly used for stomach aches or digestives (53%), for colds (23%), menstrual cramps (4%) or to menstruate (2%). The remaining part of the study consisted in the visual and chemical analysis of the plant species cited by the interviewees, including other species that have been popularly used as a method of abortion. Comparative visual analysis of medicinal plants (Group A-C) from four different shops showed the absence of quality control concerning packing specifications and the separation of the plant material to be consumed. The analysis of the chemical profiles of these samples by thin layer chromatography (TLC) and high performance liquid chromatography (HPLC) indicated that those species belonging to the Group C were significantly different from those plants having the same identification, except for Peumus boldus, whose samples were similar in terms of chemical composition.

Uma atividade de educação em saúde para puérperas num alojamento conjunto

The Rooming favors the permanence of the mother with the newborn, thus establishing a stronger link between the mother and baby, in addition, care assistance and guidance are essential to both through the health care team because they recognize the moments critical that their interventions are necessary to ensure the health of both. The educational lecture was an option to have the opportunity to assist, guide and answer possible questions that may arise for mothers, and also to assess the knowledge of puéperas regarding the care of babies and self care. There was participation from 40 patients. In the study methodology was developed a questionnaire containing two subjects (self-care and care for newborns) was given to patients before and after the lecture held by the author in a rooming Maternity HC de Botucatu. The results were analyzed statistically and studied by the author, allowing note that many significant results were obtained after the lecture, which we realize that the same intervention on self-care was significant in respect of: bleeding, infection in the genital tract and urinary tract, surgical dehiscence , care of the lower limbs and constipation, how to care for the newborn was the significance to the questions about the hygiene of the umbilical stump, cramps, hunger, weeping and pacifiers. In the pre-lecture questions 73.00% of 27.00% were right and wrong. Our conclusion is that the mothers have a high level of prior knowledge and educational lectures enriches their knowledge in a creative and participatory

Efeitos da redução da concentração de sódio na solução de hemodiálise e no conteúdo de sódio da dieta sobre a resposta inflamatória de pacientes com doença renal crônica

Pós-graduação em Fisiopatologia em Clínica Médica - FMB

Efeitos anti-inflamatório e antitumoral dos constituintes de Qualea grandiflora no tumor de Ehrlich

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)