Manejo do Trauma Raquimedular na Emergência: uma revisão de literatura

This is an integrative review using the VHL, SciELO, LILACS and PubMed as databases over the last 5 years. 997 articles on the topic were evaluated with an emphasis on a synthesis of the most recent knowledge and greater scientific consistency. The diagnosis of TRM is carried out through clinical examination, associated with imaging tests. X-rays and computed tomography evaluate the bone structures of the spine, while magnetic resonance imaging is capable of showing injuries to the medullary neural tissue and ligament structures. Prevention of car accidents, use of safety equipment, actions in favor of disarmament and signage of places to avoid diving in shallow water; are effective measures to prevent TRM.Trata-se de uma revisão integrativa utilizando como base de dados a BVS, a SciELO, o LILACS e o PubMed, nos últimos 5 anos. Foram avaliados 997 artigos sobre o tema com ênfase em uma síntese dos conhecimentos mais recentes e de maior consistência científica. o diagnóstico do TRM é realizado por meio do exame clínico, associado aos exames de imagem. A radiografia e a tomografia computadorizada avaliam as estruturas ósseas da coluna, já ressonância magnética é capaz de mostrar lesões ao tecido neural medular e estruturas ligamentares. A prevenção de acidentes automobilísticos, uso de equipamentos de segurança, ações a favor do desarmamento e sinalização de locais para evitar mergulho em água rasa; são medidas eficazes de prevenção do TRM

Intercorrências no manejo da anestesia em pacientes obesos: uma revisão de literatura

This is an integrative review using the BVS, SciELO, LILACS and PubMed as databases over the last 5 years. 997 articles on the topic were evaluated with an emphasis on a synthesis of the most recent knowledge and greater scientific consistency. The safe approach to obese patients on an outpatient basis is, without a doubt, a challenge for the anesthesiologist who, in addition to the content of these recommendations, must always take into account the conditions of infrastructure, equipment, material and multidisciplinary team available to take complete the anesthetic act. Therefore, it is considered essential that each Ambulatory Surgery Unit draw up a local policy that takes all these variables into account.Trata-se de uma revisão integrativa utilizando como base de dados a BVS, a SciELO, o LILACS e o PubMed, nos últimos 5 anos. Foram avaliados 997 artigos sobre o tema com ênfase em uma síntese dos conhecimentos mais recentes e de maior consistência científica. A abordagem em segurança do doente obeso em regime de ambulatório constitui, sem dúvida, um desafio para o anestesiologista que, para além do conteúdo destas recomendações, deverá ter sempre em consideração, as condições de infraestrutura, equipamento, material e equipa multidisciplinar disponível para levar a cabo o ato anestésico. Por isso, considera-se fundamental a elaboração, por parte de cada Unidade de Cirurgia Ambulatória, de uma política local que tenha em conta todas estas variáveis. &nbsp

COVID-19: Is There Evidence for the Use of Herbal Medicines as Adjuvant Symptomatic Therapy?

Background: Current recommendations for the self-management of SARS-Cov-2 disease (COVID-19) include self-isolation, rest, hydration, and the use of NSAID in case of high fever only. It is expected that many patients will add other symptomatic/adjuvant treatments, such as herbal medicines. Aims: To provide a benefits/risks assessment of selected herbal medicines traditionally indicated for “respiratory diseases” within the current frame of the COVID-19 pandemic as an adjuvant treatment. Method: The plant selection was primarily based on species listed by the WHO and EMA, but some other herbal remedies were considered due to their widespread use in respiratory conditions. Preclinical and clinical data on their efficacy and safety were collected from authoritative sources. The target population were adults with early and mild flu symptoms without underlying conditions. These were evaluated according to a modified PrOACT-URL method with paracetamol, ibuprofen, and codeine as reference drugs. The benefits/risks balance of the treatments was classified as positive, promising, negative, and unknown. Results: A total of 39 herbal medicines were identified as very likely to appeal to the COVID-19 patient. According to our method, the benefits/risks assessment of the herbal medicines was found to be positive in 5 cases (Althaea officinalis, Commiphora molmol, Glycyrrhiza glabra, Hedera helix, and Sambucus nigra), promising in 12 cases (Allium sativum, Andrographis paniculata, Echinacea angustifolia, Echinacea purpurea, Eucalyptus globulus essential oil, Justicia pectoralis, Magnolia officinalis, Mikania glomerata, Pelargonium sidoides, Pimpinella anisum, Salix sp, Zingiber officinale), and unknown for the rest. On the same grounds, only ibuprofen resulted promising, but we could not find compelling evidence to endorse the use of paracetamol and/or codeine. Conclusions: Our work suggests that several herbal medicines have safety margins superior to those of reference drugs and enough levels of evidence to start a clinical discussion about their potential use as adjuvants in the treatment of early/mild common flu in otherwise healthy adults within the context of COVID-19. While these herbal medicines will not cure or prevent the flu, they may both improve general patient well-being and offer them an opportunity to personalize the therapeutic approaches

Intervenção Farmacêutica na Terapia Antirretroviral (TARV) em Pacientes Não cumpridores

No Brasil, 190.000 pacientes HIV+ utilizam a terapia antirretroviral. Embora a distribuição da medicação seja gratuita, o problema enfrentado é a não adesão do paciente à terapia, que deve ser igual ou superior a 95%. A não adesão causa o aumento da carga viral, queda dos linfócitos CD4+ e resistência viral à medicação. A complexidade da farmacoterapia, as reações adversas à medicação e a falta de conhecimento sobre HIV e os hábitos necessários para cumprir a terapia comprometem a adesão. Embora o acompanhamento farmacêutico seja eficaz na promoção do cumprimento da terapia, faltam estudos que avaliem esta influência na adesão a TARV. Propor um plano de Intervenções Farmacêuticas e Educativas para promover o cumprimento da TARV. Trata-se de um estudo prospectivo, qualitativo e semi-experimental, realizado com pacientes não cumpridores da terapia segundo o autorrelato. Foram realizados seis encontros, sendo o primeiro para anamnese, aplicação de questionários de avaliação da adesão e qualidade de vida e consulta a exames clínicos; os quatro seguintes para intervenções farmacêuticas e educativas, e o sexto para a avaliação dos mesmos critérios do primeiro encontro, e da satisfação quanto à intervenção. Os encontros contemplaram: intervenções educativas sobre a síndrome, a terapia e mudanças no estilo de vida, proposta de um instrumento para auxiliar na tomada da medicação e recomendação ao médico sobre a necessidade da avaliação laboratorial. Apenas dois pacientes participaram de todos os encontros. Estes pacientes apresentavam carga viral indetectável e contagem de linfócitos T CD4+ desejável, relataram não utilizar estratégias para lembrar-se de tomar a medicação e possuiam pouco conhecimento sobre a doença e a terapia. Durante os encontros, estabeleceram-se plano de metas individuais... (Resumo completo, clicar acesso eletrônico abaixo

Toxic effects of the administration of Mikania glomerata Sprengel during the gestational period of hypertensive rats

Herbal medicine is an ancient practice that has been gaining acceptance of the medical class through scientific studies that prove its effectiveness. However, its use should still be cautious. Medicinal plants have potential toxic effects not yet discovered, and may have unproven interactions with other medications. The use of drugs during pregnancy is still very dangerous and vigorously studied; however, there are few studies of herbal medicines in pregnant women. Existing studies prioritize on teratogenic or abortifacient effects. The aim of this study was to analyze the toxic effects of Mikania glomerata Sprengel administration, popularly known as “guaco” during the gestational period of hypertensive rats. For this experimental groups consisting of pregnant Wistar rats received treatments with guaco extract (1 to 2 mL). In order to analyze the possible toxic effects of guaco during pregnancy, weight gain of rats was assessed during pregnancy; reproductive performance of rats, morphological parameters, and fetal placental histology were compared. Although some parameters presented significant differences, we can conclude that changes prioritized by literature, such as toxicity, vasodilation and hypotension, have not been caused by guaco. The only fetal changes observed were due to the maternal hypertension. Some studies have reported vasodilator and hypotensive effects of guaco. However, only a few studies exist, and its actual effects remain unknown. Specific studies should be developed with higher doses of guaco for a definitive conclusion of its toxic and non-toxic effects.Keywords: Guaco, Hypertensive pregnant rats, Mikania glomerata, Perinatal toxicit

Toxic effects of the administration of Mikania glomerata Sprengel during the gestational period of hypertensive rats

Herbal medicine is an ancient practice that has been gaining acceptance of the medical class through scientific studies that prove its effectiveness. However, its use should still be cautious. Medicinal plants have potential toxic effects not yet discovered, and may have unproven interactions with other medications. The use of drugs during pregnancy is still very dangerous and vigorously studied; however, there are few studies of herbal medicines in pregnant women. Existing studies prioritize on teratogenic or abortifacient effects. The aim of this study was to analyze the toxic effects of Mikania glomerata Sprengel administration, popularly known as “guaco” during the gestational period of hypertensive rats. For this experimental groups consisting of pregnant Wistar rats received treatments with guaco extract (1 to 2 mL). In order to analyze the possible toxic effects of guaco during pregnancy, weight gain of rats was assessed during pregnancy; reproductive performance of rats, morphological parameters, and fetal placental histology were compared. Although some parameters presented significant differences, we can conclude that changes prioritized by literature, such as toxicity, vasodilation and hypotension, have not been caused by guaco. The only fetal changes observed were due to the maternal hypertension. Some studies have reported vasodilator and hypotensive effects of guaco. However, only a few studies exist, and its actual effects remain unknown. Specific studies should be developed with higher doses of guaco for a definitive conclusion of its toxic and non-toxic effects